Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301009105 | MI |
NPI | 1063614543 |
---|---|
Provider Name | Mrs. Jill Louise Mccarthy-Mitchell |
First Address | Orion, MI 48360-2810 |
Second Address | Orion, MI 48360-2810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |