Healthcare Provider Details

I. General information

NPI: 1033842620
Provider Name (Legal Business Name): JAMILA ELZEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 INKSTER RD
GARDEN CITY MI
48135-4117
US

IV. Provider business mailing address

25465 CLAIRVIEW DR
DEARBORN HEIGHTS MI
48127-3845
US

V. Phone/Fax

Practice location:
  • Phone: 734-338-2148
  • Fax:
Mailing address:
  • Phone: 313-898-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024679
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: