Provider Demographics
NPI:1003956608
Name:AZZAM, CHRISTIE LEE (MA, LLP, LLPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:LEE
Last Name:AZZAM
Suffix:
Gender:F
Credentials:MA, LLP, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 ACORN HILL CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-4016
Mailing Address - Country:US
Mailing Address - Phone:248-761-5810
Mailing Address - Fax:
Practice Address - Street 1:7457 FRANKLIN RD
Practice Address - Street 2:SUITE 303
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3611
Practice Address - Country:US
Practice Address - Phone:248-761-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006825101YM0800X
MI6301010402103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist