Provider Demographics
NPI:1225128499
Name:PERSHA, TINA MARIE (MA LPC CACII)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:PERSHA
Suffix:
Gender:F
Credentials:MA LPC CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52188 VANDYKE
Mailing Address - Street 2:STE 320
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316
Mailing Address - Country:US
Mailing Address - Phone:286-254-7774
Mailing Address - Fax:586-254-7766
Practice Address - Street 1:52188 VANDYKE
Practice Address - Street 2:STE 320
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48316
Practice Address - Country:US
Practice Address - Phone:286-254-7774
Practice Address - Fax:586-254-7766
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000816101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7969655OtherAETNA