Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TF0000X | Family Psychologist | ||
N | 103TP2701X | Group Psychotherapist | ||
N | 104100000X | Social Worker | ||
N | 1041C0700X | Clinical Social Worker | ||
N | 224Z00000X | Occupational Therapy Assistant | ||
N | 225100000X | Physical Therapist |
NPI | 1215592969 |
---|---|
Provider Name | Kim Nwagwu |
First Address | Northville, MI 48167-3302 |
Second Address | Northville, MI 48167-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2019 |
Last Update Date | 08/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376963538 | (05) | MI |