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General NPI Number Information
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NPI Number | 1699518795
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Entity Type | Organization
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Legal Business Name | SAFE WITH SELF BHTC
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 2109 MARTIN LUTHER KING AVE
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City | FLINT
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State | MI
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Zip | 48503-1027
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Country | US
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Telephone | 810-335-4366
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Fax |
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Provider Business Mailing Address
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Address Line | 329 LETA AVE
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City | FLINT
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State | MI
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Zip | 48507-2727
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Country | US
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Telephone | 810-335-4366
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Fax |
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Authorized Official
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Title or Position | CREDENTIALIN
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Name | HOSSAM SHUKAIRY
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Credential |
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Telephone | 810-780-4181
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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