Individual
MICOLE JANELLE JAMESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPSS
Contact information
Practice address
33505 SCHOOLCRAFT RD, LIVONIA, MI 48150-1503
(734) 629-2774
Mailing address
707 W MILWAUKEE ST, DETROIT, MI 48202-2943
(313) 344-9099
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
X120
MI
175T00000X
Peer Specialist
Primary
—
MI
Other
Enumeration date
03/08/2018
Last updated
07/17/2023
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