Individual
ABBEY MIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4434 HEATHER LN SE, GRAND RAPIDS, MI 49546-2350
(616) 916-6838
Mailing address
4434 HEATHER LN SE, GRAND RAPIDS, MI 49546-2350
(616) 916-6838
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401000506
MI
104100000X
Social Worker
6801090284
MI
Other
Enumeration date
01/10/2021
Last updated
01/10/2021
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