Basic Information
| Provider Information | |||||||||
| NPI: | 1992157713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIMA | ||||||||
| FirstName: | TEA | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.L.M.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8623 N WAYNE RD | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481851137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344250636 | ||||||||
| FaxNumber: | 7344254771 | ||||||||
| Practice Location | |||||||||
| Address1: | 8623 N WAYNE RD | ||||||||
| Address2: | |||||||||
| City: | WESTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481851137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344250636 | ||||||||
| FaxNumber: | 7344254771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2016 | ||||||||
| LastUpdateDate: | 02/13/2018 | ||||||||
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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 | 6801099710 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.