Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 6301012106 | MI |
Y | 103T00000X | Psychologist | 6301012106 | MI |
NPI | 1003902115 |
---|---|
Provider Name | Mrs. Colleen Beth Verbeke |
First Address | Warren, MI 48092-2468 |
Second Address | Detroit, MI 48234-3241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |