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General NPI Number Information
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NPI Number | 1063685022
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Entity Type | Individual
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Provider Name | HODA AMINE PHD, LMSW,CAC-LL
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Gender | Female
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 252 BILTMORE DR
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-3710
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Country | US
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Telephone | 313-561-4589
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Fax | 313-561-6660
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Provider Business Mailing Address
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Address Line | 15600 MICHIGAN AVE SUITE 201
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City | DEARBORN
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State | MI
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Zip | 48126-2944
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Country | US
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Telephone | 313-801-4673
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Fax | 313-561-6660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801058093
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License Number State | MI
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