Provider Demographics
NPI:1881200947
Name:TUMPKIN, MELINA (LLPC)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:TUMPKIN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19369 SILVER SPRING DR APT 203
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2567
Mailing Address - Country:US
Mailing Address - Phone:248-413-7095
Mailing Address - Fax:
Practice Address - Street 1:2350 WASHTENAW AVE STE 4
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4525
Practice Address - Country:US
Practice Address - Phone:734-645-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional