Provider Demographics
NPI:1437713807
Name:ALI, NADINE NABIL (TLLP)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:NABIL
Last Name:ALI
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1615
Mailing Address - Country:US
Mailing Address - Phone:248-308-3592
Mailing Address - Fax:
Practice Address - Street 1:315 GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1615
Practice Address - Country:US
Practice Address - Phone:248-308-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
MI6362009629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No156F00000XEye and Vision Services ProvidersTechnician/Technologist