Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | MI |
NPI | 1003934936 |
---|---|
Provider Name | Mrs. Angelina Joyce Ross-Berry |
First Address | Detroit, MI 48202-1426 |
Second Address | Detroit, MI 48202-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 26/07/2007 |