Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 6401017569 | MI |
N | 101YS0200X | School Counselor | SC0000001003689 | MI |
NPI | 1245858182 |
---|---|
Provider Name | Melissa Pearl Waters |
First Address | Harrison Township, MI 48045-5381 |
Second Address | Rochester Hills, MI 48309-2275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2020 |
Last Update Date | 08/07/2020 |