| NPI | 1639735061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER R BOGG Sole Member 248-758-8022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2024-08-12 |