Healthcare Provider Details

I. General information

NPI: 1366269284
Provider Name (Legal Business Name): MINDFUL MIND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22332 GARRISON ST
DEARBORN MI
48124-2228
US

IV. Provider business mailing address

22332 GARRISON ST
DEARBORN MI
48124-2228
US

V. Phone/Fax

Practice location:
  • Phone: 313-451-0484
  • Fax: 313-458-9123
Mailing address:
  • Phone: 313-451-0484
  • Fax: 313-458-9123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALAA HOJEIJ
Title or Position: CLINICAL SOCIAL WORKER
Credential: LMSW-C
Phone: 313-451-0484