Organization
IGNITE 3 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BROOKS LLP (OWNER)
(352) 552-5686
Entity
Organization
Contact information
Practice address
28491 UTICA RD, ROSEVILLE, MI 48066-2593
(352) 552-5686
Mailing address
28491 UTICA RD, ROSEVILLE, MI 48066-2593
(352) 552-5686
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
05/26/2021
Last updated
05/26/2021
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