Individual
MRS. KRIS SANDRA NICOLICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLP
Contact information
Practice address
3258 BROAD ST, DEXTER, MI 48130-1142
(734) 718-4579
Mailing address
3265 EASTRIDGE DR, DEXTER, MI 48130-9392
(734) 718-4579
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
6301011113
MI
Other
Enumeration date
08/30/2017
Last updated
08/30/2017
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