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1154767143
TIA LANISE BRAXTON
DETROIT, MI
NPI
1154767143
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: MI 6801092238)
Enumeration Date
2013-05-16
Last Update Date
2013-05-16
Business Address
-- TIA LANISE BRAXTON LMSW
2051 W GRAND BLVD
DETROIT, MI 48208-1105
Phone number: 313-961-2919
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Mailing Address
-- TIA LANISE BRAXTON LMSW
2051 W GRAND BLVD
DETROIT, MI 48208-1105
Phone number:
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