Provider Demographics
NPI:1043594781
Name:BAZZY, NADIA MARIE (MA, LLMFT)
Entity Type:Individual
Prefix:MS
First Name:NADIA
Middle Name:MARIE
Last Name:BAZZY
Suffix:
Gender:F
Credentials:MA, LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43155 MAIN ST
Mailing Address - Street 2:SUITE 2210D
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1777
Mailing Address - Country:US
Mailing Address - Phone:248-971-4881
Mailing Address - Fax:
Practice Address - Street 1:43155 MAIN ST
Practice Address - Street 2:SUITE 2210D
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1777
Practice Address - Country:US
Practice Address - Phone:248-971-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist