Provider Demographics
NPI:1992422893
Name:SAKKAB, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SAKKAB
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 1:38544 EMERALD LN N
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7636
Mailing Address - Country:US
Mailing Address - Phone:734-658-9619
Mailing Address - Fax:
Practice Address - Street 1:41740 6 MILE RD STE 103
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4383
Practice Address - Country:US
Practice Address - Phone:734-658-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist