| NPI | 1295024362 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEX J. GROSSBERG Credentialing Coordinator 248-626-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2011-03-29 |