Healthcare Provider Details

I. General information

NPI: 1073026944
Provider Name (Legal Business Name): RASCHA AZAKIR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 11/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD STE 300
SOUTHFIELD MI
48075-3729
US

IV. Provider business mailing address

21760 CECILE ST
DEARBORN HEIGHTS MI
48127
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-3301
  • Fax: 248-849-5349
Mailing address:
  • Phone: 248-849-3301
  • Fax: 248-849-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801098296
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: