Provider Demographics
NPI:1033424999
Name:GANT, TAMIEKA (MA LLPC)
Entity Type:Individual
Prefix:MS
First Name:TAMIEKA
Middle Name:
Last Name:GANT
Suffix:
Gender:F
Credentials:MA LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3104
Mailing Address - Country:US
Mailing Address - Phone:313-285-9645
Mailing Address - Fax:248-659-1528
Practice Address - Street 1:1386 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3104
Practice Address - Country:US
Practice Address - Phone:313-285-9645
Practice Address - Fax:248-659-1528
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool