Individual
CHRISTINE BETH WILSON DE MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.,L.L.P.
Contact information
Practice address
W-4111 ANDOVER ROAD, BLOOMFIELD HILLS, MI 48302
(248) 290-5400
Mailing address
17719 ODYSSEY, BELLEVILLE, MI 48111-9152
(248) 943-6151
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
L915934
MI
Other
Enumeration date
05/28/2019
Last updated
05/28/2019
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