Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401011423 | MI |
NPI | 1003111527 |
---|---|
Provider Name | Ms. Sarah Jane Kirby |
First Address | Madison Heights, MI 48071-1541 |
Second Address | Madison Heights, MI 48071-1541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2011 |
Last Update Date | 14/01/2011 |