Provider Demographics
NPI:1891323416
Name:CREPEAU, THOMAS P (LMSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:CREPEAU
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40824 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3073
Mailing Address - Country:US
Mailing Address - Phone:586-855-0554
Mailing Address - Fax:
Practice Address - Street 1:40824 MICHAEL ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3073
Practice Address - Country:US
Practice Address - Phone:586-855-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801094223104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker