Individual
KINNETA EASTER MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
41825 BORCHART DR, NOVI, MI 48375-3328
(313) 919-1801
Mailing address
41825 BORCHART DR, NOVI, MI 48375-3328
(313) 919-1801
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301015176
MI
103T00000X
Psychologist
Primary
6361003738
MI
103TC1900X
Counseling Psychologist
6301015176
MI
Other
Enumeration date
08/02/2012
Last updated
08/05/2022
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