Provider Demographics
NPI:1356478721
Name:DINES, TAMMY LYNNE (LMSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNNE
Last Name:DINES
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37875 W 12 MILE RD
Mailing Address - Street 2:#203
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3043
Mailing Address - Country:US
Mailing Address - Phone:248-788-7011
Mailing Address - Fax:
Practice Address - Street 1:37875 W 12 MILE RD
Practice Address - Street 2:#203
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3043
Practice Address - Country:US
Practice Address - Phone:248-788-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010466951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008974650OtherBLUE CROSS BLUE SHIELD PI
MI4228566OtherAETNA PIN