Healthcare Provider Details

I. General information

NPI: 1477223303
Provider Name (Legal Business Name): MRS. CAROLINE KOBBAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 LEWIS AVE
TEMPERANCE MI
48182-9583
US

IV. Provider business mailing address

3261 GLENDALE ST
DETROIT MI
48238-3332
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-3802
  • Fax:
Mailing address:
  • Phone: 313-247-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851110771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: