Provider Demographics
NPI:1710620059
Name:DAVID, TAMMIE LOUISE (LMSW-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:LOUISE
Last Name:DAVID
Suffix:
Gender:F
Credentials:LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 LIZA LN
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3177
Mailing Address - Country:US
Mailing Address - Phone:248-705-1864
Mailing Address - Fax:
Practice Address - Street 1:165 LIZA LN
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-3177
Practice Address - Country:US
Practice Address - Phone:248-705-1864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010869631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical