Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist |
NPI | 1174274989 |
---|---|
Provider Name | Amber Mccrary |
First Address | Detroit, MI 48227-2341 |
Second Address | Detroit, MI 48227-2341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2022 |
Last Update Date | 13/01/2022 |