Healthcare Provider Details

I. General information

NPI: 1922881580
Provider Name (Legal Business Name): RENEWED HOPE MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 NIGHTINGALE ST
DEARBORN MI
48128-1564
US

IV. Provider business mailing address

804 NIGHTINGALE ST
DEARBORN MI
48128-1564
US

V. Phone/Fax

Practice location:
  • Phone: 313-318-4004
  • Fax:
Mailing address:
  • Phone: 313-318-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JEAN-MARIE JAMEILLA EL FAKHOURY
Title or Position: FOUNDER
Credential: LMSW
Phone: 313-318-4004