Healthcare Provider Details

I. General information

NPI: 1124932249
Provider Name (Legal Business Name): SARA GHASSAN HAJHASSAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23500 PARK ST
DEARBORN MI
48124-2598
US

IV. Provider business mailing address

26360 LAWRENCE DR
DEARBORN HEIGHTS MI
48127-4907
US

V. Phone/Fax

Practice location:
  • Phone: 313-877-3347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: