Provider Demographics
NPI:1114457868
Name:ANCOUNI, FATME A
Entity Type:Individual
Prefix:
First Name:FATME
Middle Name:A
Last Name:ANCOUNI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23713 STERLING PL
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1669
Mailing Address - Country:US
Mailing Address - Phone:313-414-3093
Mailing Address - Fax:
Practice Address - Street 1:23713 STERLING PL
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1669
Practice Address - Country:US
Practice Address - Phone:313-414-3093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247000000X
MI6801114479104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information