Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 6802072487 | MI |
NPI | 1003261488 |
---|---|
Provider Name | Yolanda Farr |
First Address | Detroit, MI 48207-4274 |
Second Address | Detroit, MI 48207-4274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 04/05/2016 |