Doctor Name: | ANGELA NICOLE PRYOR |
NPI Number: | 1114365277 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 45589 Utica Grn W Shelby Twp, MI - 483175167 |
Business Phone Number: | 5862125677 |
Business Fax Number: | |
Mailing Address: | 45589 Utica Grn W, SHELBY TWP |
State: | MI |
Postal Code: | 483175167 |
Phone Number: | 5862125677 |
Fax Number: | |
NPI Enumeration Date: | 06/11/2013 |
NPI Last Update Date: | 06/11/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TM1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Mental Retardation & Developmental Disabilities |
Taxonomy Definition: |