Individual
LINDA RILEY HATHORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
17352 W 12 MILE RD, SUITE 100, SOUTHFIELD, MI 48076-2119
(248) 559-0730
(248) 569-7626
Mailing address
833 SEVILLE ROW, DETROIT, MI 48202-2601
(313) 971-4343
(248) 569-7626
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401005921
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401005921
STATE OF MICHIGAN LICENCE
MI
Enumeration date
05/30/2008
Last updated
05/30/2008
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