Provider Demographics
NPI:1982294161
Name:GAMBLE, TASIA
Entity type:Individual
Prefix:
First Name:TASIA
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COLUMBIA AVE E STE F561
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3737
Mailing Address - Country:US
Mailing Address - Phone:734-664-6533
Mailing Address - Fax:
Practice Address - Street 1:30 COLUMBIA AVE E STE F
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3737
Practice Address - Country:US
Practice Address - Phone:734-664-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker