Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 820317 | MI |
NPI | 1003079039 |
---|---|
Provider Name | Mrs. Mary Marshall |
First Address | Highland Park, MI 48203-3274 |
Second Address | Highland Park, MI 48203-3274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 09/07/2008 |