Individual
DR. ANICE ROBINSON MODESTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
214 WILDER TOWER, UNIVERSITY OF MEMPHIS, CCL&T, MEMPHIS, TN 38152-3520
(901) 678-2068
Mailing address
5828 HAYMARKET RD, MEMPHIS, TN 38120-3011
(901) 820-0033
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
P1152
TN
Other
Enumeration date
06/29/2007
Last updated
07/19/2007
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