Provider Demographics
NPI:1396914826
Name:HEMINGWAY, TIESHA NICOLE (FAODP)
Entity type:Individual
Prefix:
First Name:TIESHA
Middle Name:NICOLE
Last Name:HEMINGWAY
Suffix:
Gender:F
Credentials:FAODP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12644 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1881
Mailing Address - Country:US
Mailing Address - Phone:313-409-7152
Mailing Address - Fax:
Practice Address - Street 1:13336 E WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2112
Practice Address - Country:US
Practice Address - Phone:313-822-6940
Practice Address - Fax:313-822-6946
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)