Provider Demographics
NPI:1033425913
Name:STEVENS, TANISE MARCELL (CPC-I)
Entity Type:Individual
Prefix:
First Name:TANISE
Middle Name:MARCELL
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 MIDDLEBELT
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174
Mailing Address - Country:US
Mailing Address - Phone:734-629-5000
Mailing Address - Fax:734-722-8390
Practice Address - Street 1:6700 MIDDLEBELT RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-2039
Practice Address - Country:US
Practice Address - Phone:734-629-5000
Practice Address - Fax:734-722-8390
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker