Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5201006955 | MI |
NPI | 1538688122 |
---|---|
Provider Name | Allyson Drew Gorman |
First Address | Troy, MI 48083 |
Second Address | Troy, MI 48083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2017 |
Last Update Date | 14/09/2017 |