Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401005840 | MI |
N | 103TC1900X | Counseling Psychologist | 6301009543 | MI |
NPI | 1114348232 |
---|---|
Provider Name | Mrs. Amy Maggini |
First Address | Muskegon, MI 49441-1976 |
Second Address | Muskegon, MI 49441-1976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2013 |
Last Update Date | 16/12/2013 |