Individual
DR. GORDON E. MACKINNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH. D.
Contact information
Practice address
17336 W 12 MILE RD STE 101, SOUTHFIELD, MI 48076-2113
(248) 583-9362
(248) 879-6774
Mailing address
17336 W 12 MILE RD STE 101, SOUTHFIELD, MI 48076-2113
(248) 583-9362
(248) 879-6774
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301006861
MI
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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