| NPI | 1558598995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICKA ARLENE JACKSON Owner 586-549-1842 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301008884) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2009-11-02 |