Individual
TAMIKA L. MATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW, LPC
Contact information
Practice address
1025 E FOREST AVE, DETROIT, MI 48207-1024
(313) 664-6814
(313) 833-5973
Mailing address
812 LOTHROP RD, DETROIT, MI 48202-2736
(313) 802-6546
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401010407
MI
104100000X
Social Worker
6802076257
MI
Other
Enumeration date
12/08/2017
Last updated
12/08/2017
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