Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 640101436 | MI |
N | 101YS0200X | School Counselor | SC0000000793839 | MI |
NPI | 1194193953 |
---|---|
Provider Name | Marilyn Booker |
First Address | Grand Rapids, MI 49525-1010 |
Second Address | Grand Rapids, MI 49525-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2015 |
Last Update Date | 10/09/2015 |