Individual
TAMMY BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1641 ALTER RD, DETROIT, MI 48215-3114
(313) 903-0639
Mailing address
220 MANISTIQUE ST, DETROIT, MI 48215-3114
(313) 903-0639
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6451017246
MI
Other
Enumeration date
11/10/2021
Last updated
11/26/2021
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