Healthcare Provider Details

I. General information

NPI: 1306986070
Provider Name (Legal Business Name): TERESA DIANE TOKARCZYK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 HARRIS AVE
TAWAS CITY MI
48763-9681
US

IV. Provider business mailing address

1632 M 30
ALGER MI
48610-8541
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-8636
  • Fax:
Mailing address:
  • Phone: 989-362-8636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801081336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: