Provider Demographics
NPI:1124392071
Name:SAFO, HAITHAM A (LPC)
Entity Type:Individual
Prefix:DR
First Name:HAITHAM
Middle Name:A
Last Name:SAFO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 15 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5232
Mailing Address - Country:US
Mailing Address - Phone:313-283-7981
Mailing Address - Fax:
Practice Address - Street 1:2311 15 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5232
Practice Address - Country:US
Practice Address - Phone:313-283-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401009738OtherLISCENCE NUMBER