Provider Demographics
NPI:1831906924
Name:ROCK, KATIE M (LMSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:M
Last Name:ROCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:M
Other - Last Name:TILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:26725 PALMER BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3526
Mailing Address - Country:US
Mailing Address - Phone:248-764-0921
Mailing Address - Fax:
Practice Address - Street 1:26725 PALMER BLVD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3526
Practice Address - Country:US
Practice Address - Phone:248-764-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801108331104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker