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General NPI Number Information
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NPI Number | 1174932255
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Entity Type | Individual
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Provider Name | TIHESA MACK LMSW,ACSW
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Gender | Female
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 2425 S LINDEN RD STE D138
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City | FLINT
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State | MI
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Zip | 48532-5482
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Country | US
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Telephone | 810-644-2128
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 314
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-0314
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Country | US
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Telephone | 810-644-2128
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801086122
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License Number State | MI
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