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Individual

VICKY AVERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
13560 E MCNICHOLS RD, DETROIT, MI 48205-3426
(313) 883-3300
(313) 731-0156
Mailing address
62 MASSACHUSETTS ST, HIGHLAND PARK, MI 48203-3537
(313) 282-5832
(313) 731-0156

Taxonomy

Speciality
Code
Description
License number
State
405300000X
Prevention Professional
Primary
823032
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1134502354
MI
Enumeration date
05/23/2017
Last updated
07/21/2022
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