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General NPI Number Information
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NPI Number | 1447864129
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Entity Type | Individual
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Provider Name | RAPHAEL ANTONIO TRAMBLE LMSW
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Gender | Male
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 42669 GARFIELD RD
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-1653
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Country | US
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Telephone | 800-395-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 17403 WOODINGHAM DR
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City | DETROIT
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State | MI
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Zip | 48221-4505
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Country | US
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Telephone | 313-623-9112
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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 | 6801116311
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6801099987
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License Number State | MI
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