Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 6401011020 | MI |
N | 101YP2500X | Professional Counselor | L1556549 | MI |
Y | 103TC1900X | Counseling Psychologist | L1393931 | MI |
NPI | 1114155330 |
---|---|
Provider Name | Ms. Christine Dievendorf Weiss |
First Address | Kalamazoo, MI 49009-2161 |
Second Address | Kalamazoo, MI 49009-2161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 17/03/2018 |