Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | L1950490 | MI |
NPI | 1043570187 |
---|---|
Provider Name | Ms. Kristle R. White |
First Address | Warren, MI 48089-1069 |
Second Address | Wayne, MI 48184-1628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2012 |
Last Update Date | 23/05/2012 |