Provider Demographics
NPI:1477127033
Name:DATTA, THROIE (TD)
Entity type:Individual
Prefix:
First Name:THROIE
Middle Name:
Last Name:DATTA
Suffix:
Gender:F
Credentials:TD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3545
Mailing Address - Country:US
Mailing Address - Phone:586-263-8920
Mailing Address - Fax:586-286-3832
Practice Address - Street 1:1800 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3545
Practice Address - Country:US
Practice Address - Phone:586-263-8920
Practice Address - Fax:586-286-3832
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician