Provider Demographics
NPI:1316215395
Name:MWENDWA, JAMIL HAKIM (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMIL
Middle Name:HAKIM
Last Name:MWENDWA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21401 LYNDON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-1905
Mailing Address - Country:US
Mailing Address - Phone:313-445-7438
Mailing Address - Fax:
Practice Address - Street 1:21630 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3209
Practice Address - Country:US
Practice Address - Phone:313-445-7438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical