Individual
DIANE LIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LP
Contact information
Practice address
443 N STATE ST, CARO, MI 48723-1539
(989) 673-5700
(989) 672-2555
Mailing address
467 N STATE ST, CARO, MI 48723-1539
(989) 672-6160
(989) 672-5649
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301006179
MI
Other
Enumeration date
05/10/2006
Last updated
10/30/2007
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