Individual
MRS. MICHELLE ELAINE SAMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA-LLPC
Contact information
Practice address
13101 ALLEN RD, SOUTHGATE, MI 48195-2216
(734) 785-7700
Mailing address
24218 GRAND TRAVERSE AVE, BROWNSTOWN, MI 48134-8051
(734) 642-8658
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6401012299
MI
Other
Enumeration date
02/16/2012
Last updated
06/11/2012
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