Healthcare Provider Details

I. General information

NPI: 1821754656
Provider Name (Legal Business Name): TAVIA HILL LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 S TELEGRAPH RD
BLOOMFIELD HILLS MI
48302-0285
US

IV. Provider business mailing address

2537 W HICKORY GROVE RD
BLOOMFIELD HILLS MI
48302-0842
US

V. Phone/Fax

Practice location:
  • Phone: 800-395-3223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: