Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 6301002806 | MI |
NPI | 1215172580 |
---|---|
Provider Name | Dr. Sandra R Champe |
First Address | West Bloomfield, MI 48322-3704 |
Second Address | West Bloomfield, MI 48322-3704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 01/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MI1332 | (02) | MI |