Provider Demographics
NPI:1932250313
Name:MIDDLETON, TAMMY GAIL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:GAIL
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W GRIXDALE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-4558
Mailing Address - Country:US
Mailing Address - Phone:313-867-4132
Mailing Address - Fax:
Practice Address - Street 1:101 W GRIXDALE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48203-4558
Practice Address - Country:US
Practice Address - Phone:313-867-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010882051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical