Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1083373674 |
---|---|
Provider Name | Rachel Mannino |
First Address | Ferndale, MI 48220-1361 |
Second Address | Ferndale, MI 48220-1361 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2021 |
Last Update Date | 11/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
STUDENT | SLIDING SCALE FEE (01) | MI |