Provider Demographics
NPI:1457486698
Name:FADOIR, STEVEN JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:FADOIR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:31300 NORTHWESTERN HIGHWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48344
Mailing Address - Country:US
Mailing Address - Phone:248-737-9903
Mailing Address - Fax:248-737-9963
Practice Address - Street 1:31330 NORTHWESTERN HWY
Practice Address - Street 2:SUITE D
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2560
Practice Address - Country:US
Practice Address - Phone:248-737-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301006008OtherPSYCHOLOGIST LICENSE-FULL
MI38-3553483OtherFEDERAL TAX ID