Provider Demographics
NPI:1750783734
Name:RICHARDS, TRACY ANN (LLMSW)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24401 CAPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-1343
Mailing Address - Country:US
Mailing Address - Phone:586-783-2950
Mailing Address - Fax:
Practice Address - Street 1:24401 CAPITAL BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1343
Practice Address - Country:US
Practice Address - Phone:586-783-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-21
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010972001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical