Healthcare Provider Details

I. General information

NPI: 1184589830
Provider Name (Legal Business Name): JAMILLA JASMIN DABISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 23 MILE RD STE 103
SHELBY TOWNSHIP MI
48315-2767
US

IV. Provider business mailing address

5770 GREGORY DR
UTICA MI
48317-2813
US

V. Phone/Fax

Practice location:
  • Phone: 586-210-6148
  • Fax:
Mailing address:
  • Phone: 586-431-4847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451024433
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: