Provider Demographics
NPI:1275205429
Name:KHAMORO, DONOVAN (LLMSW)
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:
Last Name:KHAMORO
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6951 CROSSWELL DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3029
Mailing Address - Country:US
Mailing Address - Phone:248-836-8571
Mailing Address - Fax:
Practice Address - Street 1:6951 CROSSWELL DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3029
Practice Address - Country:US
Practice Address - Phone:248-836-8571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health