Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1114598240 |
---|---|
Provider Name | Mr. Ardrace D Morris |
First Address | Caledonia, MI 49316-7970 |
Second Address | Grand Rapids, MI 49546-2137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2021 |
Last Update Date | 09/07/2021 |