Provider Demographics
NPI:1508100405
Name:ATIYEH, SHADIN RIEM (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHADIN
Middle Name:RIEM
Last Name:ATIYEH
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25507 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1555
Mailing Address - Country:US
Mailing Address - Phone:313-292-7640
Mailing Address - Fax:313-292-9270
Practice Address - Street 1:2245 S. STATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-769-0209
Practice Address - Fax:734-769-0224
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional