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Individual

KANE SHERROD MORRIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LLC

Contact information

Practice address
2925 RUSSELL ST, DETROIT, MI 48207-4825
(248) 820-2079
Mailing address
6309 MACK AVE, DETROIT, MI 48207-2302
(248) 820-2079

Taxonomy

Speciality
Code
Description
License number
State
103TF0000X
Family Psychologist
Primary
802166677
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
V0811119F
MI
Enumeration date
06/26/2019
Last updated
08/12/2019
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