Individual
MRS. DIANE LYNETTE INNES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LLP
Contact information
Practice address
26300 OUTER DR, LINCOLN PARK, MI 48146-2019
(313) 388-4630
(313) 388-4672
Mailing address
11217 SOUTHWORTH AVE, PLYMOUTH, MI 48170-4466
(734) 927-4645
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301010778
MI
Other
Enumeration date
04/11/2007
Last updated
07/08/2007
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