Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401011801 | MI |
NPI | 1003168592 |
---|---|
Provider Name | Alicia Monique Lurry |
First Address | Detroit, MI 48239-1116 |
Second Address | Detroit, MI 48239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2012 |
Last Update Date | 29/05/2018 |