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General NPI Number Information
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NPI Number | 1700117025
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Entity Type | Individual
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Provider Name | CAMELA R. AYOUB TAKACH M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 5840 LORAC SUITE 4
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City | CLARKSTON
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State | MI
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Zip | 48346
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Country | US
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Telephone | 248-657-2370
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Fax | 248-592-7925
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Provider Business Mailing Address
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Address Line | 3910 MAIDEN ST
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City | WATERFORD
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State | MI
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Zip | 48329-1047
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Country | US
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Telephone | 248-515-1733
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Fax | 248-592-7925
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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 | 6801020223
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License Number State | MI
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