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1194069500
JACQUELINE DIANE PARKS
SOUTHGATE, MI
NPI
1194069500
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
103T00000X Psychologist
(Licence: MI 6301015305)
Enumeration Date
2012-11-26
Last Update Date
2012-11-26
Business Address
-- JACQUELINE DIANE PARKS MA, TLLP
19291 NORTHLINE RD
SOUTHGATE, MI 48195-2220
Phone number: 734-785-7700
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Mailing Address
-- JACQUELINE DIANE PARKS MA, TLLP
2485 W EUCLID ST
DETROIT, MI 48206-2441
Phone number: 313-728-5519
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