Healthcare Provider Details

I. General information

NPI: 1861955742
Provider Name (Legal Business Name): NADER HABHAB LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6549 TOWN CENTER DR STE A
CLARKSTON MI
48346-4824
US

IV. Provider business mailing address

6549 TOWN CENTER DR STE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 248-620-6400
  • Fax: 313-624-9418
Mailing address:
  • Phone: 248-620-6400
  • Fax: 313-624-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451022457
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: