Provider Demographics
NPI:1811495880
Name:HUBBARD, TAMEKA LATREICE (TLLP)
Entity type:Individual
Prefix:
First Name:TAMEKA
Middle Name:LATREICE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 TOWN CENTER DR STE 328
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2795
Mailing Address - Country:US
Mailing Address - Phone:248-430-0594
Mailing Address - Fax:
Practice Address - Street 1:330 TOWN CENTER DR STE 328
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2795
Practice Address - Country:US
Practice Address - Phone:248-430-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362010178103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist