Individual
MARK SOUTAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLP
Contact information
Practice address
2881 MONROE ST, SUITE #201, DEARBORN, MI 48124-3475
(313) 359-1977
Mailing address
6549 TOWN CENTER DR STE A, CLARKSTON, MI 48346-4824
(248) 620-6400
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6301015605
MI
103TC0700X
Clinical Psychologist
Primary
6361003953
MI
Other
Enumeration date
10/15/2014
Last updated
04/30/2020
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