Healthcare Provider Details

I. General information

NPI: 1821438474
Provider Name (Legal Business Name): PENELOPE LYNN TOHM CADC-M, B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W. FIFTH AVE GENESEE HEALTH SYSTEM
FLINT MI
48503
US

IV. Provider business mailing address

420 W. FIFTH AVE GENESEE HEALTH SYSTEM
FLINT MI
48503
US

V. Phone/Fax

Practice location:
  • Phone: 989-785-9892
  • Fax:
Mailing address:
  • Phone: 989-785-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: