Provider Demographics
NPI:1063685022
Name:AMINE, HODA (PHD, LMSW,CAC-LL)
Entity Type:Individual
Prefix:DR
First Name:HODA
Middle Name:
Last Name:AMINE
Suffix:
Gender:F
Credentials:PHD, LMSW,CAC-LL
Other - Prefix:PROF
Other - First Name:HODA
Other - Middle Name:AMINE
Other - Last Name:SAFIEDINE-MAJED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, CAC-II
Mailing Address - Street 1:15600 MICHIGAN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2944
Mailing Address - Country:US
Mailing Address - Phone:313-801-4673
Mailing Address - Fax:313-561-6660
Practice Address - Street 1:252 BILTMORE DR
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-3710
Practice Address - Country:US
Practice Address - Phone:313-561-4589
Practice Address - Fax:313-561-6660
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010580931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical