Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301008711 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301008711 | MI |
NPI | 1013005305 |
---|---|
Provider Name | Dr. Effie Kokkinos |
First Address | Portage, MI 49024-5826 |
Second Address | Kalamazoo, MI 49008-1205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |