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NPI Code Detail

MEDICARE: MS. TINA MARIE DEQUIN LLMSW

MEDICARE: MS. TINA MARIE DEQUIN LLMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801086442MI

General Provider Information

NPI Number : 1386678589
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TINA MARIE DEQUIN LLMSW
Provider Business Mailing Address
First Line : 24477 OLDE ORCHARD ST
Second Line :
City : NOVI
State : MI
Zip : 48375-2975
Country : US
Telephone Number : 248-252-7650
Fax Number :
Provider Business Practice Location Address
First Line : 43825 MICHIGAN AVE
Second Line :
City : CANTON
State : MI
Zip : 48188-2551
Country : US
Telephone Number : 734-397-3088
Fax Number : 734-397-2892
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/08/2007

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