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General NPI Number Information
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NPI Number | 1154095123
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Entity Type | Individual
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Provider Name | TANYANNE LEE PITTMAN
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 17348 W 12 MILE RD STE 106
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City | SOUTHFIELD
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State | MI
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Zip | 48076-6325
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Country | US
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Telephone | 888-492-9386
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 760224
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-0224
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801069877
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License Number State | MI
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