Most Relevant Information
Provider Data
NPI Number: | 1003514019 |
Provider Name: | MACKENZIE MICHAEL CRANDALL LLPC, MA, TLLP |
Entity Type: | Individual |
Taxonomy Code: | 101Y00000X |
Specialty: | Counselor |
License Number: | 6451022802 |
Most Important Dates
Enumeration Date: | 02/20/2023 |
Last Updated: | 06/19/2023 |
Provider Practice Location
5980 S MAIN ST STE 101
CLARKSTON
MI
483462377
Practice Location Phone/Fax
Phone: | 2486252970 |
Fax: |
Provider Mailing Location
2375 WALTON BLVD UNIT 4
ROCHESTER HILLS
MI
483091459
Provider Mailing Phone/Fax
Phone: | 2482008023 |
Fax: |