Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | MI |
NPI | 1003454372 |
---|---|
Provider Name | Sara E Grivetti |
First Address | East Lansing, MI 48823-1410 |
Second Address | East Lansing, MI 48823-1410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2019 |
Last Update Date | 17/12/2019 |