| NPI | 1538459326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKIYAH JACKSON Psychologist 810-596-5348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI 6301014667) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2011-04-13 |