| NPI | 1760171300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK G SAMPSON Psychologist 734-255-8062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-05-01 |