Healthcare Provider Details

I. General information

NPI: 1861730012
Provider Name (Legal Business Name): NESSRIN MOUFID SAYED LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2013
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13840 W WARREN AVE
DEARBORN MI
48126-1425
US

IV. Provider business mailing address

13840 W. WARREN
DEARBORN MI
48126
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-7287
  • Fax:
Mailing address:
  • Phone: 313-581-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401013455
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: