Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301006362 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301006362 | MI |
NPI | 1003902487 |
---|---|
Provider Name | Christine Homer |
First Address | Clinton Township, MI 48036 |
Second Address | Shelby Township, MI 48317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |