Provider Demographics
NPI:1275793697
Name:HABIB, THERESA ANN (MS, LLP,CBIS)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:HABIB
Suffix:
Gender:F
Credentials:MS, LLP,CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26729 W CARNEGIE PARK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-6165
Mailing Address - Country:US
Mailing Address - Phone:248-417-7674
Mailing Address - Fax:248-354-7477
Practice Address - Street 1:26729 W CARNEGIE PARK DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-6165
Practice Address - Country:US
Practice Address - Phone:248-417-7674
Practice Address - Fax:248-354-7477
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008272103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral