Provider Demographics
NPI:1952727257
Name:ORUM, TAKARA
Entity Type:Individual
Prefix:
First Name:TAKARA
Middle Name:
Last Name:ORUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21399 TULANE AVE
Mailing Address - Street 2:APT. 301
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5675
Mailing Address - Country:US
Mailing Address - Phone:313-995-7241
Mailing Address - Fax:
Practice Address - Street 1:21399 TULANE AVE
Practice Address - Street 2:APT. 301
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336
Practice Address - Country:US
Practice Address - Phone:313-995-7241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIO6507853855071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical