Individual
TERI LAURIE COLVIN
Active
Individual
TERI LAURIE COLVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
820174
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38-1917278
—
MI
Enumeration date
12/17/2019
Last updated
12/17/2019
Update your record
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