Provider Demographics
NPI:1124658125
Name:JONAH, ALIJAH (MSW)
Entity type:Individual
Prefix:
First Name:ALIJAH
Middle Name:
Last Name:JONAH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 BAKER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1196
Mailing Address - Country:US
Mailing Address - Phone:734-649-6348
Mailing Address - Fax:734-580-2922
Practice Address - Street 1:2820 BAKER RD STE 100
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1196
Practice Address - Country:US
Practice Address - Phone:734-649-6348
Practice Address - Fax:734-580-2922
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801106325104100000X
MI68011142021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801114202OtherSTATE OF MICHIGAN - DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS