Individual
DONOVAN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10683 S SAGINAW ST STE B, GRAND BLANC, MI 48439-8127
(810) 771-4074
Mailing address
10683 S SAGINAW ST STE B, GRAND BLANC, MI 48439-8127
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6362009852
MI
103TC0700X
Clinical Psychologist
Primary
6362009852
MI
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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