Most Relevant Information
Provider Data
| NPI Number: | 1003321357 |
| Provider Name: | TAMIKA L. MATLOCK BSW, LPC |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | 6802076257 |
Most Important Dates
| Enumeration Date: | 12/08/2017 |
| Last Updated: | 12/08/2017 |
Provider Practice Location
1025 E FOREST AVE
DETROIT
MI
482071024
Practice Location Phone/Fax
| Phone: | 3136646814 |
| Fax: | 3138335973 |
Provider Mailing Location
812 LOTHROP RD
DETROIT
MI
482022736
Provider Mailing Phone/Fax
| Phone: | 3138026546 |
| Fax: |