Provider Demographics
NPI:1225224900
Name:MOBLEY, TAMIKA MACHELLE (MSW)
Entity Type:Individual
Prefix:
First Name:TAMIKA
Middle Name:MACHELLE
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20051 BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2010
Mailing Address - Country:US
Mailing Address - Phone:313-729-9758
Mailing Address - Fax:
Practice Address - Street 1:20051 BRENTWOOD ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2010
Practice Address - Country:US
Practice Address - Phone:313-729-9758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18878911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical