Individual
MR. BRENTON PLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A., L.L.P.C.
Contact information
Practice address
114 ORCHARD LAKE RD, PONTIAC, MI 48341-2244
(248) 858-7766
Mailing address
114 ORCHARD LAKE RD, PONTIAC, MI 48341-2244
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401012507
MI
Other
Enumeration date
01/13/2012
Last updated
01/13/2012
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