Provider Demographics
NPI:1194905414
Name:TUMA, GEORGIA SHERYLL (LLMSW)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:SHERYLL
Last Name:TUMA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:SHERYLL
Other - Last Name:CALKINS-GODIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSU
Mailing Address - Street 1:2657 NEIBEL ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2644
Mailing Address - Country:US
Mailing Address - Phone:313-467-1944
Mailing Address - Fax:
Practice Address - Street 1:2657 NEIBEL ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-2644
Practice Address - Country:US
Practice Address - Phone:313-467-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086266104100000X
MI68010862266104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MINI8210027OtherMEDICARE