Healthcare Provider Details

I. General information

NPI: 1609143536
Provider Name (Legal Business Name): KRISTIN DEWS NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 LIVERNOIS RD STE 101
TROY MI
48083-1603
US

IV. Provider business mailing address

2221 LIVERNOIS RD STE 101
TROY MI
48083-1603
US

V. Phone/Fax

Practice location:
  • Phone: 248-544-0360
  • Fax: 248-544-0388
Mailing address:
  • Phone: 248-544-0360
  • Fax: 248-544-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number773453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: