Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | C00640 | MI |
NPI | 1285800870 |
---|---|
Provider Name | Ms. Deborah Ann Bogle |
First Address | Troy, MI 48083-5151 |
Second Address | Troy, MI 48083-5151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2008 |
Last Update Date | 02/05/2008 |