Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 103TC1900X | Counseling Psychologist | ||
N | 103TH0100X | Health Service |
NPI | 1487013488 |
---|---|
Provider Name | Carol Miracle |
First Address | Northville, MI 48167-9799 |
Second Address | Northville, MI 48167-9799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2016 |
Last Update Date | 18/02/2016 |