person
Loretta Bantom
Professional Counselor in Detroit, Michigan
NPI 1013448059

Loretta Bantom is a Professional Counselor based in Detroit, MI and is specialized in Professional. Loretta Bantom practices in Detroit, MI. The NPI Number for Loretta Bantom is 1013448059 and holds a License No. 6401015420 (Michigan).

The current practice location address for Loretta Bantom is 79 W Alexandrine St, Detroit, MI and can be reached out via phone at 313-831-5535 and via fax at 313-831-2608.

Location: 79 W Alexandrine St, Detroit, MI, 48201-2015
person
Provider Profile Details
NPI Number
1013448059
Provider Name
Loretta Bantom
Credential
Provider Entity Type
Individual
Gender
Female
Address
79 W Alexandrine St, Detroit, MI, 48201-2015
Phone Number
313-831-5535
Fax Number
313-831-2608
Provider Enumeration Date
03/22/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
79 W Alexandrine St
City
State
Zip
48201-2015
Phone Number
313-831-5535
Fax Number
313-831-2608
person
Provider Business Mailing Address Details
Address
79 W Alexandrine St
City
State
Zip
48201-2015
Phone Number
313-831-5535
Fax Number
313-831-2608
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
6401015420 (Michigan)
Definition
Definition to come...
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