Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301003050 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301003050 | MI |
NPI | 1003833708 |
---|---|
Provider Name | Diane B Lothrop |
First Address | Livonia, MI 48150-3896 |
Second Address | Livonia, MI 48150-3896 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 15/03/2017 |