Healthcare Provider Details

I. General information

NPI: 1083525299
Provider Name (Legal Business Name): LILLIAN KHATIB MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

901 S WASHINGTON AVE
LUDINGTON MI
49431-2571
US

IV. Provider business mailing address

6524 DUNEVIEW DR
LUDINGTON MI
49431-9011
US

V. Phone/Fax

Practice location:
  • Phone: 734-899-7185
  • Fax:
Mailing address:
  • Phone: 616-916-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: