Healthcare Provider Details

I. General information

NPI: 1871254672
Provider Name (Legal Business Name): MEISAA SALLOUM ABBAS LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23930 MICHIGAN AVE
DEARBORN MI
48124-1833
US

IV. Provider business mailing address

43911 6 MILE RD
NORTHVILLE MI
48168-9591
US

V. Phone/Fax

Practice location:
  • Phone: 248-897-9588
  • Fax:
Mailing address:
  • Phone: 248-897-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851094614
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: