Provider Demographics
NPI:1952676181
Name:SIMS, TINA MARIE (LMSW CAADC BSW)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:SIMS
Suffix:
Gender:F
Credentials:LMSW CAADC BSW
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:KOCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:1109 S CHIMNEY HILL DR
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9573
Mailing Address - Country:US
Mailing Address - Phone:517-668-0312
Mailing Address - Fax:
Practice Address - Street 1:4902 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-5474
Practice Address - Country:US
Practice Address - Phone:517-394-7867
Practice Address - Fax:517-394-7867
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MI12942171100000X
MI68010924541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171100000XOther Service ProvidersAcupuncturist