| NPI | 1598326738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY BULLOCK Owner / Lmsw 248-505-5043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2019-06-27 |