Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6301011727 | MI |
Y | 103TF0000X | Family Psychologist | 6301011727 | MI |
NPI | 1467624593 |
---|---|
Provider Name | Ms. Tina Marie Wheeler |
First Address | Garden City, MI 48135-4001 |
Second Address | Garden City, MI 48135-4001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2008 |
Last Update Date | 28/03/2008 |