| NPI | 1790293488 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARKITA THOMPSON Authorized Official 313-613-9392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2020-08-26 |