Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6401005233 | MI |
NPI | 1063865830 |
---|---|
Provider Name | Gloria A. Love |
First Address | West Bloomfield, MI 48325 |
Second Address | Detroit, MI 48234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2016 |
Last Update Date | 18/07/2016 |