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Individual

LAMAURICE H GARDNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
22250 PROVIDENCE DR, SUITE 207, SOUTHFIELD, MI 48075-4825
(313) 576-1000
Mailing address
22250 PROVIDENCE DR, SUITE 207, SOUTHFIELD, MI 48075-4825
(313) 576-1000

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301007265
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
680F34976
BLUE CROSS MICHIGAN
MI
Enumeration date
06/28/2006
Last updated
07/08/2007
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