Basic Information
| Provider Information | |||||||||
| NPI: | 1629123963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINGL | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | M | ||||||||
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| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HACKETT | ||||||||
| OtherFirstName: | THERESA | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12145 SPENCER RD | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483802737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102276335 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30701 WOODWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480730987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482889333 | ||||||||
| FaxNumber: | 2482881362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801086980 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.