Provider Demographics
NPI:1700117025
Name:TAKACH, CAMELA R AYOUB (MSW)
Entity Type:Individual
Prefix:MS
First Name:CAMELA
Middle Name:R AYOUB
Last Name:TAKACH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:CAMELA
Other - Middle Name:R
Other - Last Name:AYOUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3910 MAIDEN ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-1047
Mailing Address - Country:US
Mailing Address - Phone:248-515-1733
Mailing Address - Fax:248-592-7925
Practice Address - Street 1:5840 LORAC
Practice Address - Street 2:SUITE 4
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346
Practice Address - Country:US
Practice Address - Phone:248-657-2370
Practice Address - Fax:248-592-7925
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010202231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical