Individual
MICHELLE RENEE VICTORIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP PHD
Contact information
Practice address
44000 W 12 MILE RD STE 101, NOVI, MI 48377-2646
(248) 226-3001
(248) 347-6479
Mailing address
44000 W 12 MILE RD, NOVI, MI 48377-2644
(856) 981-0894
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301018352
MI
103TC0700X
Clinical Psychologist
SI5583
NJ
Other
Enumeration date
02/26/2016
Last updated
10/09/2020
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