Healthcare Provider Details

I. General information

NPI: 1134845985
Provider Name (Legal Business Name): DINA BAIDOUN LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26734 CLAIRVIEW DR
DEARBORN HEIGHTS MI
48127-1644
US

IV. Provider business mailing address

31700 TELEGRAPH RD STE 235
BINGHAM FARMS MI
48025-3466
US

V. Phone/Fax

Practice location:
  • Phone: 313-443-4339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362007734
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: