Provider Demographics
NPI:1538552633
Name:ROSS, TAWANNA D (MA, LPC)
Entity type:Individual
Prefix:
First Name:TAWANNA
Middle Name:D
Last Name:ROSS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51074 MOTT RD TRLR 28
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2139
Mailing Address - Country:US
Mailing Address - Phone:734-725-1143
Mailing Address - Fax:
Practice Address - Street 1:5958 N CANTON CENTER RD STE 900
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2740
Practice Address - Country:US
Practice Address - Phone:734-737-1200
Practice Address - Fax:734-737-1205
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451017686101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor