Healthcare Provider Details

I. General information

NPI: 1700094166
Provider Name (Legal Business Name): MAHA SULAIMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24636 ROUGE RIVER DR
DEARBORN HEIGHTS MI
48127-1766
US

IV. Provider business mailing address

24636 ROUGE RIVER DR
DEARBORN HEIGHTS MI
48127-1766
US

V. Phone/Fax

Practice location:
  • Phone: 310-666-9196
  • Fax:
Mailing address:
  • Phone: 313-887-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: