Healthcare Provider Details

I. General information

NPI: 1598659732
Provider Name (Legal Business Name): MARIA ELLAHIE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GENOA BUSINESS PARK DR
BRIGHTON MI
48114-5328
US

IV. Provider business mailing address

24346 TERRA DEL MAR DR
NOVI MI
48374-2533
US

V. Phone/Fax

Practice location:
  • Phone: 810-220-2787
  • Fax:
Mailing address:
  • Phone: 248-924-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851120432
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: