Provider Demographics
NPI:1386161172
Name:LOVE, TANISHA ARLESE (LMSW)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:ARLESE
Last Name:LOVE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7256 ROCKDALE
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1017
Mailing Address - Country:US
Mailing Address - Phone:313-923-7574
Mailing Address - Fax:313-722-4768
Practice Address - Street 1:3800 PURITAN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-1313
Practice Address - Country:US
Practice Address - Phone:313-923-7574
Practice Address - Fax:313-722-4768
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010981681041C0700X
MI68011111701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid