Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301015176 | MI |
Y | 103T00000X | Psychologist | 6301015176 | MI |
N | 103TC1900X | Counseling Psychologist | 6301015176 | MI |
NPI | 1093061517 |
---|---|
Provider Name | Kinneta Easter Mason |
First Address | Detroit, MI 48219-2069 |
Second Address | Detroit, MI 48219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2012 |
Last Update Date | 20/08/2018 |