Healthcare Provider Details

I. General information

NPI: 1992877096
Provider Name (Legal Business Name): CHRISTINE MARY NOWICKI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 MILLER RD SUITE B
SWARTZ CREEK MI
48473
US

IV. Provider business mailing address

PO BOX 215012
AUBURN HILLS MI
48321-5012
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-3979
  • Fax:
Mailing address:
  • Phone: 810-733-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301005510
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: