Healthcare Provider Details

I. General information

NPI: 1619587706
Provider Name (Legal Business Name): HAWRAA KHALIL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
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:
Mailing address:
  • Phone: 313-451-0484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: