Provider Demographics
NPI:1124841812
Name:GHAMLOUCHE, DANIELLE ELIZABETH (CPRM,CADC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:GHAMLOUCHE
Suffix:
Gender:F
Credentials:CPRM,CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23025 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1852
Mailing Address - Country:US
Mailing Address - Phone:313-695-2250
Mailing Address - Fax:
Practice Address - Street 1:21415 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4247
Practice Address - Country:US
Practice Address - Phone:734-375-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty