| NPI | 1609223825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER WYNGAARD Practice Manager 734-772-0148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 133V00000X Dietitian, Registered | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2019-10-24 |