Individual
MS. CHARISSE PORZONDEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
35425 W MICHIGAN AVE, WAYNE, MI 48184-1687
(877) 407-2500
Mailing address
692 BREAKWATER DR, BELLEVILLE, MI 48111-4471
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301007093
—
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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