Individual
KEVIN EZELL SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLPC
Contact information
Practice address
1410 S TELEGRAPH RD, BLOOMFIELD HILLS, MI 48302-0046
(248) 456-8150
Mailing address
1623 E MADGE AVE, HAZEL PARK, MI 48030-2172
(313) 424-0101
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401014781
MI
Other
Enumeration date
01/10/2018
Last updated
01/10/2018
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