Individual
AUSTIN JAMES AVISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1360 PORTER ST, DEARBORN, MI 48124-2890
(313) 689-5188
Mailing address
1308 S MAIN ST, PLYMOUTH, MI 48170
(734) 451-3440
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6362009961
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
05/12/2022
Last updated
07/11/2024
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