Provider Information for 1538731666
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MICHELLE DEANNA TAVERNER LMSW
Sex: Female
NPI: 1538731666
Last Updated: 2021-07-16
Certification Date: 2021-07-16
Certification Date: 2021-07-16
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1538731666 | ||||||||||||||
| Enumeration Date | 2021-07-16 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 24367 ROMA RIDGE DR NOVI, MI 48374-2963 United States Phone: 734-536-1680 | Fax: | ||||||||||||||
| Primary Practice Address | 24367 ROMA RIDGE DR NOVI, MI 48374 United States Phone: 734-536-1680 | Fax: | ||||||||||||||
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