Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301009825 | MI |
NPI | 1093827529 |
---|---|
Provider Name | Louise Legge |
First Address | Flint, MI 48507-1923 |
Second Address | Westland, MI 48185-3095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 09/07/2007 |