| NPI | 1912521360 |
|---|---|
| Former Name | CANDICE PETROVICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6361000496) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6361000496) |
| 103TC1900X Psychologist, Counseling (Licence: MI 6361000496) | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2024-04-25 |