Provider Demographics
NPI:1770071201
Name:WOODS, TACARA LAKAISHA (LMSW, CTP-C)
Entity type:Individual
Prefix:
First Name:TACARA
Middle Name:LAKAISHA
Last Name:WOODS
Suffix:
Gender:F
Credentials:LMSW, CTP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-0753
Mailing Address - Country:US
Mailing Address - Phone:313-308-5510
Mailing Address - Fax:313-429-7649
Practice Address - Street 1:23543 BOLAM AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-2232
Practice Address - Country:US
Practice Address - Phone:313-308-5510
Practice Address - Fax:313-429-7649
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010974581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical