Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5201008776 | MI |
NPI | 1881099976 |
---|---|
Provider Name | Alexandra Carmichael |
First Address | Jackson, MI 49202-2180 |
Second Address | Jackson, MI 49202-2180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2014 |
Last Update Date | 31/10/2014 |