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General NPI Number Information
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NPI Number | 1649210931
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Entity Type | Individual
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Provider Name | DAVID MICHAEL CONNELL PHD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | INNER WISDOM COUNSELING 224 S. MAIN
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City | NORTHVILLE
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State | MI
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Zip | 48167
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Country | US
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Telephone | 248-348-1270
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Fax | 248-347-3393
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Provider Business Mailing Address
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Address Line | 27787 MARTINDALE RD
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City | NEW HUDSON
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State | MI
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Zip | 48165-9601
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Country | US
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Telephone | 248-264-6400
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Fax | 248-347-3393
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301005242
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License Number State | MI
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