| NPI | 1659674059 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKIYAH SHANI' JACKSON Consultative Services 810-257-3714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301014667) |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2010-12-08 |