| NPI | 1902104680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LEE JENKINS Owner 248-506-9515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301013418) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2011-03-04 |