Provider Demographics
NPI:1174932255
Name:MACK, TIHESA (LMSW,ACSW)
Entity type:Individual
Prefix:
First Name:TIHESA
Middle Name:
Last Name:MACK
Suffix:
Gender:F
Credentials:LMSW,ACSW
Other - Prefix:
Other - First Name:TIHESA
Other - Middle Name:
Other - Last Name:CHISOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-0314
Mailing Address - Country:US
Mailing Address - Phone:810-644-2128
Mailing Address - Fax:
Practice Address - Street 1:2425 S LINDEN RD STE D138
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5482
Practice Address - Country:US
Practice Address - Phone:810-644-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086122104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker