Individual
MS. TEMEKIA M WYCKOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
153 CALIFORNIA ST, HIGHLAND PARK, MI 48203-3517
(313) 468-0673
Mailing address
PO BOX 563, SOUTHFIELD, MI 48037-0563
(313) 468-0673
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
802268787
MI
103TP2701X
Group Psychotherapy Psychologist
802268787
MI
171M00000X
Case Manager/Care Coordinator
802268787
MI
251E00000X
Home Health Agency
802268787
MI
251K00000X
Public Health or Welfare Agency
Primary
802268787
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
802268787
—
MI
Enumeration date
03/15/2019
Last updated
03/15/2019
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