Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 103TC1900X | Counseling Psychologist | ||
N | 174N00000X | Lactation Consultant |
NPI | 1235697848 |
---|---|
Provider Name | Wafa Haddad |
First Address | Wyoming, MI 49519-6308 |
Second Address | Wyoming, MI 49519-6308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 06/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CV0018047 | (05) | MI |
CV0018047 | CASE MANAGEMENT (01) | MI |