Provider Demographics
NPI:1154744118
Name:GORE, TASHA T (LMSW-C)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:T
Last Name:GORE
Suffix:
Gender:
Credentials:LMSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23131 MICHIGAN AVE STE 1163
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2020
Mailing Address - Country:US
Mailing Address - Phone:313-720-9205
Mailing Address - Fax:
Practice Address - Street 1:31546 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4777
Practice Address - Country:US
Practice Address - Phone:313-720-9205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011003051041C0700X
1041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator