Provider Demographics
NPI:1396101069
Name:HAZIME, MANAL
Entity type:Individual
Prefix:
First Name:MANAL
Middle Name:
Last Name:HAZIME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4117
Mailing Address - Country:US
Mailing Address - Phone:734-338-2148
Mailing Address - Fax:347-338-2164
Practice Address - Street 1:577 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4117
Practice Address - Country:US
Practice Address - Phone:734-338-2148
Practice Address - Fax:248-354-4979
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health