Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301010949 | MI |
Y | 103G00000X | Clinical Psychologist | 6301010949 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301010949 | MI |
NPI | 1508143926 |
---|---|
Provider Name | Carrie Dorrance |
First Address | Hastings, MI 49058-9018 |
Second Address | Hastings, MI 49058-9018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2011 |
Last Update Date | 09/03/2017 |