Basic Information
| Provider Information | |||||||||
| NPI: | 1679837769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TATRO | ||||||||
| FirstName: | CANDICE | ||||||||
| MiddleName: | MAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4720 BROWN RD | ||||||||
| Address2: | |||||||||
| City: | VASSAR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487689101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106915050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1420 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485046208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102380475 | ||||||||
| FaxNumber: | 8102389270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2012 | ||||||||
| LastUpdateDate: | 07/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401013138 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.