Provider Demographics
NPI:1003541574
Name:AKANAN, MARIAM (LLMSW)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:AKANAN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7296 MAYBURN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1762
Mailing Address - Country:US
Mailing Address - Phone:313-788-3643
Mailing Address - Fax:
Practice Address - Street 1:22811 GREATER MACK AVE STE 111
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2053
Practice Address - Country:US
Practice Address - Phone:586-335-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851115403104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker