Individual
DIANE MCCORMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
366 BELANGER ST, GROSSE POINTE FARMS, MI 48236-3334
(313) 885-1385
(313) 884-6432
Mailing address
366 BELANGER ST, GROSSE POINTE FARMS, MI 48236-3334
(313) 885-1385
(313) 884-6432
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301007909
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680H247980
BCBSM
MI
Enumeration date
06/28/2006
Last updated
09/03/2009
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