Individual
CHARLES VANAUKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11000 W MCNICHOLS RD, DETROIT, MI 48221-2357
(313) 340-4442
Mailing address
11000 W MCNICHOLS RD, DETROIT, MI 48221-2357
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320121988
—
MI
Enumeration date
08/14/2014
Last updated
08/14/2014
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