Provider Demographics
NPI:1629123963
Name:LINGL, THERESA M (LMSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:LINGL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12145 SPENCER RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48380-2737
Mailing Address - Country:US
Mailing Address - Phone:810-227-6335
Mailing Address - Fax:
Practice Address - Street 1:30701 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0987
Practice Address - Country:US
Practice Address - Phone:248-288-9333
Practice Address - Fax:248-288-1362
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010869801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical