Basic Information
| Provider Information | |||||||||
| NPI: | 1922456961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMKIN | ||||||||
| FirstName: | JACQUELINE | ||||||||
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| Credential: | MA, TLLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12216 CORVAIR DR | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483124028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487216600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26522 VAN DYKE AVE | ||||||||
| Address2: | |||||||||
| City: | CENTER LINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480151221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867594400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2016 | ||||||||
| LastUpdateDate: | 06/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301016575 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.