Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301015781 | MI |
NPI | 1104302322 |
---|---|
Provider Name | Veronica Nichole Thomas |
First Address | Livonia, MI 48150-1317 |
Second Address | Livonia, MI 48150-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |