Healthcare Provider Details

I. General information

NPI: 1396101069
Provider Name (Legal Business Name): MANAL HAZIME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 INKSTER RD
GARDEN CITY MI
48135-4117
US

IV. Provider business mailing address

577 INKSTER RD
GARDEN CITY MI
48135-4117
US

V. Phone/Fax

Practice location:
  • Phone: 734-338-2148
  • Fax: 248-354-4979
Mailing address:
  • Phone: 734-338-2148
  • Fax: 347-338-2164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401015069
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: