Healthcare Provider Details

I. General information

NPI: 1831050582
Provider Name (Legal Business Name): VIVIANE AKENG MBAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 CARSON LN
MONROE MI
48162-9515
US

IV. Provider business mailing address

2109 CARSON LN
MONROE MI
48162-9515
US

V. Phone/Fax

Practice location:
  • Phone: 313-819-5130
  • Fax:
Mailing address:
  • Phone: 313-819-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number4704421206
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: