Healthcare Provider Details

I. General information

NPI: 1023691805
Provider Name (Legal Business Name): MANAR ABOUL-NOUR MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8290 PROMENADE CIR
SHELBY TWP MI
48316-2664
US

IV. Provider business mailing address

8290 PROMENADE CIR
SHELBY TWP MI
48316-2664
US

V. Phone/Fax

Practice location:
  • Phone: 804-874-1672
  • Fax:
Mailing address:
  • Phone: 804-874-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451023437
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225948
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451023437
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401225948
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225948
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023437
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: