Organization
MICKI LEVIN JD PHD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICKI LEVIN JD PHD (OWNER)
(248) 644-3371
Entity
Organization
Contact information
Practice address
43902 WOODWARD AVE, SUITE 118, BLOOMFIELD HILLS, MI 48302-5011
(248) 644-3371
(248) 644-5033
Mailing address
43902 WOODWARD AVE, SUITE 118, BLOOMFIELD HILLS, MI 48302-5011
(248) 644-3371
(248) 644-5033
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301005211
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680F34901
BLUE CROSS SHIELD MICHIGAN
MI
Enumeration date
03/27/2009
Last updated
03/27/2009
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