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General NPI Number Information
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NPI Number | 1063927085
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Entity Type | Organization
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Legal Business Name | BRIGHT PINE, INC.
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 12/13/2017
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Provider Practice Location Address
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Address Line | 6913 FOX LN
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City | WATERFORD
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State | MI
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Zip | 48327-3506
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Country | US
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Telephone | 248-404-8816
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Fax |
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Provider Business Mailing Address
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Address Line | 6913 FOX LN
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City | WATERFORD
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State | MI
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Zip | 48327-3506
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Country | US
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Telephone | 248-404-8816
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST, DIRECTOR
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Name | DR. KATHERINE ANN LEWITZKE
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Credential | PSYD, LP
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Telephone | 248-404-8816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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