Healthcare Provider Details

I. General information

NPI: 1285227967
Provider Name (Legal Business Name): ASIA AMIR HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37640 HILLCREST DR
WAYNE MI
48184-2806
US

IV. Provider business mailing address

37640 HILLCREST DR
WAYNE MI
48184-2806
US

V. Phone/Fax

Practice location:
  • Phone: 734-674-5273
  • Fax:
Mailing address:
  • Phone: 734-674-5173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009241
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: