Individual
MS. TANYA DELORISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
707 W MILWAUKEE ST, DETROIT, MI 48202-2943
(313) 344-9099
Mailing address
119 GARFIELD ST APT 405, DETROIT, MI 48201-1988
(813) 447-1935
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6451018990
MI
Other
Enumeration date
07/19/2012
Last updated
08/21/2024
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