Individual
ELAINA NICOLE GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30640 LONGCREST ST, SOUTHFIELD, MI 48076-1562
(248) 798-4807
Mailing address
30640 LONGCREST ST., SOUTHFIELD, MI 48076-1562
(248) 798-4807
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
G635201630597
MI
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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