Provider Information for 1457864613
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TIA LENEE GITGOOD LMSW
Sex: Female
NPI: 1457864613
Last Updated: 2017-11-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1457864613 | ||||||||
| Enumeration Date | 2017-11-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 19445 W WARREN AVE DETROIT, MI 48228-3361 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 19445 W WARREN AVE DETROIT, MI 48228-3361 United States Phone: 313-558-9397 | Fax:734-661-4501 | ||||||||
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