| NPI | 1376700559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA LYNNETTE MARTIN Clinical Psychologist 313-271-8170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MI 63001008325) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2008-05-16 |