Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 6801099664 | MI |
NPI | 1003269036 |
---|---|
Provider Name | Holly Metzger |
First Address | Clarkston, MI 48346-4824 |
Second Address | Livonia, MI 48150-1805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2016 |
Last Update Date | 14/07/2016 |