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General NPI Number Information
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NPI Number | 1033842497
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Entity Type | Individual
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Provider Name | AALIYAH ANJANIQUE LARKIN-JACKSON
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Gender | Female
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Dates
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Enumeration Date | 07/05/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 24600 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2471
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Country | US
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Telephone | 248-745-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 8920 NOTTINGHAM DR
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City | YPSILANTI
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State | MI
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Zip | 48198-3228
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Country | US
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Telephone | 734-961-2536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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