Provider Demographics
NPI:1912690082
Name:PATTON, TINA M (LLMSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:PATTON
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 1:415 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49094-9503
Mailing Address - Country:US
Mailing Address - Phone:517-677-1117
Mailing Address - Fax:
Practice Address - Street 1:200 VISTA DR
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1776
Practice Address - Country:US
Practice Address - Phone:517-278-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851116448104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker