Healthcare Provider Details

I. General information

NPI: 1063323566
Provider Name (Legal Business Name): LENA KHALIL HEZAM ALHAMIDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4936 OGDEN ST
DETROIT MI
48210-2069
US

IV. Provider business mailing address

4936 OGDEN ST
DETROIT MI
48210-2069
US

V. Phone/Fax

Practice location:
  • Phone: 313-406-4586
  • Fax: 313-447-3256
Mailing address:
  • Phone: 313-406-4586
  • Fax: 313-447-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberA900000760733
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: