Individual
MICHELE LAVONNE SQUIRES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1950 MADISON AVE, MEMPHIS, TN 38104-2707
(901) 522-1002
Mailing address
1950 MADISON AVE, MEMPHIS, TN 38104-2707
(901) 522-1002
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LDC0000001045
TN
Other
Enumeration date
04/20/2021
Last updated
04/20/2021
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