Provider Demographics
NPI:1306225230
Name:HADDAD, WADAD
Entity Type:Individual
Prefix:
First Name:WADAD
Middle Name:
Last Name:HADDAD
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 1:21821 MAUER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3544
Mailing Address - Country:US
Mailing Address - Phone:586-774-3408
Mailing Address - Fax:
Practice Address - Street 1:21821 MAUER ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3544
Practice Address - Country:US
Practice Address - Phone:586-774-3408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MI320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional