Healthcare Provider Details

I. General information

NPI: 1215869615
Provider Name (Legal Business Name): ADAM TABAK LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E OAKLEY PARK RD
COMMERCE TOWNSHIP MI
48390-1500
US

IV. Provider business mailing address

9409 N HAGGERTY RD
PLYMOUTH MI
48170-4696
US

V. Phone/Fax

Practice location:
  • Phone: 734-219-9488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: