Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003230095 |
---|---|
Provider Name | Mr. Darren Kilgore |
First Address | Detroit, MI 48207-4258 |
Second Address | Detroit, MI 48207-4258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2014 |
Last Update Date | 11/02/2014 |