Provider Demographics
NPI:1043376114
Name:CURTIS, JOAN ALLISON (PHD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ALLISON
Last Name:CURTIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:J
Other - Middle Name:ALLISON
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5639 SASHABAW RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3149
Mailing Address - Country:US
Mailing Address - Phone:248-922-9077
Mailing Address - Fax:
Practice Address - Street 1:5639 SASHABAW RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-3149
Practice Address - Country:US
Practice Address - Phone:248-922-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11274321OtherCAQH