Provider Demographics
NPI:1083274773
Name:HAMMOUDAH, NANCY (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:HAMMOUDAH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772263
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2263
Mailing Address - Country:US
Mailing Address - Phone:800-693-1916
Mailing Address - Fax:248-605-3525
Practice Address - Street 1:17940 FARMINGTON RD STE 302
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3159
Practice Address - Country:US
Practice Address - Phone:800-693-1916
Practice Address - Fax:248-605-3525
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6351000927103T00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician