Provider Demographics
NPI:1033844758
Name:MEGIVERN, TAIMI JOSEPHINE (LMSW, DP-C)
Entity Type:Individual
Prefix:
First Name:TAIMI
Middle Name:JOSEPHINE
Last Name:MEGIVERN
Suffix:
Gender:F
Credentials:LMSW, DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5131
Mailing Address - Country:US
Mailing Address - Phone:734-975-1602
Mailing Address - Fax:
Practice Address - Street 1:1710 DHU VARREN RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9261
Practice Address - Country:US
Practice Address - Phone:734-369-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010937241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical