Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1194826792 |
---|---|
Provider Name | Greg Oliver |
First Address | Dearborn, MI 48126-2749 |
Second Address | Dearborn, MI 48126-2749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 17/03/2021 |