Provider Demographics
NPI:1356630651
Name:ARAB AMERICAN AND CHALDEAN COUNCIL
Entity Type:Organization
Organization Name:ARAB AMERICAN AND CHALDEAN COUNCIL
Other - Org Name:ACC - WARREN SITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAFA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:313-893-6172
Mailing Address - Street 1:62 W. 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-1967
Mailing Address - Country:US
Mailing Address - Phone:313-893-6172
Mailing Address - Fax:313-893-0064
Practice Address - Street 1:13840 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1425
Practice Address - Country:US
Practice Address - Phone:313-581-7287
Practice Address - Fax:313-581-7318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARAB AMERICAN AND CHALDEAN COUNCIL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-07
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 251S00000X
MI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3434247Medicaid
MI0H28585OtherBCBS
MI0N99590Medicare PIN