Healthcare Provider Details

I. General information

NPI: 1699518795
Provider Name (Legal Business Name): SAFE WITH SELF BHTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 MARTIN LUTHER KING AVE
FLINT MI
48503-1027
US

IV. Provider business mailing address

329 LETA AVE
FLINT MI
48507-2727
US

V. Phone/Fax

Practice location:
  • Phone: 810-335-4366
  • Fax:
Mailing address:
  • Phone: 810-335-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: HOSSAM SHUKAIRY
Title or Position: CREDENTIALIN
Credential:
Phone: 810-780-4181