Individual
IDA VERONICA COLQUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
245 PITKIN ST, HIGHLAND PARK, MI 48203-3737
(313) 865-1500
Mailing address
20690 WAYLAND ST, SOUTHFIELD, MI 48076-5666
(248) 763-0801
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301013981
MI
163W00000X
Registered Nurse
4704425366
MI
Other
Enumeration date
03/20/2009
Last updated
09/03/2025
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