Provider Demographics
NPI:1104458447
Name:MUSHEINESH, MALAKI ISSA
Entity type:Individual
Prefix:
First Name:MALAKI
Middle Name:ISSA
Last Name:MUSHEINESH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34046 NORTHWICK ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-2277
Mailing Address - Country:US
Mailing Address - Phone:248-228-4544
Mailing Address - Fax:
Practice Address - Street 1:34046 NORTHWICK ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-2277
Practice Address - Country:US
Practice Address - Phone:248-228-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI242961410351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical