Individual
KEVIN BRUCE KNICKERBOCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
8454 N HENDERSON RD, DAVISON, MI 48423-9318
(810) 834-7769
Mailing address
8454 N HENDERSON RD, DAVISON, MI 48423-9318
(810) 834-7769
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401000014
MI
Other
Enumeration date
11/18/2022
Last updated
11/18/2022
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