Provider Demographics
NPI:1336311257
Name:AJAYI-NABORS, MARGARET O (PHP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:O
Last Name:AJAYI-NABORS
Suffix:
Gender:F
Credentials:PHP
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:O
Other - Last Name:AJAYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 W MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1209
Mailing Address - Country:US
Mailing Address - Phone:269-312-8686
Mailing Address - Fax:269-220-5333
Practice Address - Street 1:350 E MICHIGAN AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3800
Practice Address - Country:US
Practice Address - Phone:269-206-1480
Practice Address - Fax:269-366-4946
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012355103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist