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General NPI Number Information
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NPI Number | 1073480893
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Entity Type | Organization
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Legal Business Name | T'MIA PATRICK, MA, LLC
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 2041 175TH ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-1001
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Country | US
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Telephone | 802-662-3838
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Fax | 802-662-3839
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Provider Business Mailing Address
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Address Line | 2041 175TH ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-1001
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Country | US
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Telephone | 802-662-3838
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Fax | 802-662-3839
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Authorized Official
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Title or Position | ROSTERED PSYCHOTHERAPIST
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Name | MS. T'MIA PATRICK
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Credential | MA
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Telephone | 802-662-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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