Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 6401006825 | MI |
N | 102L00000X | Psychologist | 6301010402 | MI |
N | 103T00000X | Psychologist | 6301010402 | MI |
NPI | 1003956608 |
---|---|
Provider Name | Mrs. Christie Lee Azzam |
First Address | West Bloomfield, MI 48323-4016 |
Second Address | Bloomfield Hills, MI 48301-3611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |