Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801092257 | MI |
NPI | 1003153008 |
---|---|
Provider Name | David A Enterline |
First Address | Lansing, MI 48910-6818 |
Second Address | Lansing, MI 48910-6818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2013 |
Last Update Date | 16/06/2017 |