Individual
KELLY MAINVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13305 REECK ROAD, SOUTHGATE, MI 48195-3197
(734) 225-2090
(734) 225-2091
Mailing address
6549 TOWN CENTER DR, SUITE A, CLARKSTON, MI 48346-4824
(248) 620-6400
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401014254
MI
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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