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NPI Code Detail

MEDICARE: MS. TARA M. TODD CAC-1

MEDICARE:  MS. TARA M. TODD  CAC-1
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1740305507
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TARA M. TODD CAC-1
Provider Business Mailing Address
First Line : 9605 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48204-2139
Country : US
Telephone Number : 313-834-5930
Fax Number : 313-834-4541
Provider Business Practice Location Address
First Line : 9605 GRAND RIVER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48204-2139
Country : US
Telephone Number : 313-834-5930
Fax Number : 313-834-4541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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Directions to “ MS. TARA M. TODD CAC-1” Practice Location

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