| NPI | 1265979397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN BANE GVENTER Psychologist 248-303-1382 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301013477) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2017-01-28 |