Individual provider · Type 1 NPI
Loretta Bantom
Professional Counselor · Detroit, MI
NPI number
1013448059
Active
Practice location
79 W Alexandrine St
Detroit, MI 48201-2015
Fax (313) 831-2608
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | 6401015420 (MI) |
Professional Counselor: Definition to come...
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About NPI 1013448059
Loretta Bantom's National Provider Identifier is 1013448059, issued on Mar 22, 2017. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Detroit, MI. The record was last updated on Mar 22, 2017.