Healthcare Provider Details

I. General information

NPI: 1780410480
Provider Name (Legal Business Name): MS. CHRISTINE M SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 FORT ST
LINCOLN PARK MI
48146-1915
US

IV. Provider business mailing address

11051 WAYNE RD
LIVONIA MI
48150-2678
US

V. Phone/Fax

Practice location:
  • Phone: 313-382-7861
  • Fax:
Mailing address:
  • Phone: 313-522-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: