Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401016922 | MI |
NPI | 1003374836 |
---|---|
Provider Name | Mrs. Sarah Beth Bovan |
First Address | Detroit, MI 48206-2219 |
Second Address | Livonia, MI 48150-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2019 |
Last Update Date | 11/03/2019 |