Healthcare Provider Details

I. General information

NPI: 1871100602
Provider Name (Legal Business Name): SBH VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 06/12/2021
Certification Date: 06/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5734 KINGSBURY ST
DEARBORN HEIGHTS MI
48127-3118
US

IV. Provider business mailing address

5734 KINGSBURY ST
DEARBORN HEIGHTS MI
48127-3118
US

V. Phone/Fax

Practice location:
  • Phone: 313-258-2583
  • Fax:
Mailing address:
  • Phone: 313-258-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANAA NADIM HAIDAR
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 313-258-2583