Healthcare Provider Details

I. General information

NPI: 1427055680
Provider Name (Legal Business Name): TANYA JOYCE ROCK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA JOYCE BLACKMER LMSW

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 11/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 E SANDY TRL
ATLANTA MI
49709-8956
US

IV. Provider business mailing address

1921 MARSAC ST
BAY CITY MI
48708-8525
US

V. Phone/Fax

Practice location:
  • Phone: 989-785-4444
  • Fax: 989-785-4444
Mailing address:
  • Phone: 989-619-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801066400
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: