Provider Demographics
NPI:1427406149
Name:THIEDE, CHARLENE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:THIEDE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 E WEST MAPLE RD SUITE D407
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3801
Mailing Address - Country:US
Mailing Address - Phone:248-624-3812
Mailing Address - Fax:
Practice Address - Street 1:2945 E WEST MAPLE RD SUITE D407
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3801
Practice Address - Country:US
Practice Address - Phone:248-624-3812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical