Healthcare Provider Details

I. General information

NPI: 1801300397
Provider Name (Legal Business Name): NOHA KHALAFAWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOHAWAND KHALAF MA, MSW, LLMSW

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 W 7 MILE RD
DETROIT MI
48203-1967
US

IV. Provider business mailing address

8048 RIVERDALE ST
DEARBORN HEIGHTS MI
48127-1500
US

V. Phone/Fax

Practice location:
  • Phone: 313-893-6172
  • Fax: 313-893-0064
Mailing address:
  • Phone: 313-585-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801101192
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: