Individual
JENNIFER CANTRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MALLP
Contact information
Practice address
25882 ORCHARD LAKE RD, SUITE L5A, FARMINGTON HILLS, MI 48336-1292
(248) 208-6996
Mailing address
25882 ORCHARD LAKE RD, SUITE L5A, FARMINGTON HILLS, MI 48336-1292
(248) 208-6996
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301007094
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301007094
LICENSE NUMBER
—
Enumeration date
03/30/2009
Last updated
03/30/2009
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