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General NPI Number Information
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NPI Number | 1396097457
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Entity Type | Individual
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Provider Name | FARTIMA TUCKER L.M.S.W
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Gender | Female
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 35230 E MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-3698
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Country | US
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Telephone | 313-303-7423
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Fax | 734-345-4104
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Provider Business Mailing Address
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Address Line | PO BOX 125
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City | BELLEVILLE
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State | MI
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Zip | 48112-0125
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Country | US
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Telephone | 313-303-7423
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Fax | 734-345-4104
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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 | 6801094903
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | MI
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