| NPI | 1437464229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINE PROCTOR Owner 269-405-0653 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301013553) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801069783) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2010-08-17 |