Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6301008875 | MI |
Y | 103G00000X | Clinical Psychologist | 6301008875 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301008875 | MI |
N | 103TH0004X | Health Psychologist | 6301008875 | MI |
NPI | 1053315960 |
---|---|
Provider Name | Kimberly Chin Bialik |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48108-5721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 12/12/2019 |