Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1003197245 |
---|---|
Provider Name | Ms. Lyneah R Blake-Duncan |
First Address | Plymouth, MI 48170-1524 |
Second Address | Plymouth, MI 48170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2011 |
Last Update Date | 18/10/2018 |