Provider Demographics
NPI:1194250837
Name:WHITE, TAMARA (MA, LPC, CRC CBIS)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LPC, CRC CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TOWN CTR
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1135
Mailing Address - Country:US
Mailing Address - Phone:313-588-6671
Mailing Address - Fax:
Practice Address - Street 1:2000 TOWN CTR
Practice Address - Street 2:SUITE 1900
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1135
Practice Address - Country:US
Practice Address - Phone:313-588-6671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015770101YP2500X
MI6401017183101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional