Provider Demographics
NPI:1508371147
Name:ALKHULAIDI, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ALKHULAIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 BLANCHE ST
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1913
Mailing Address - Country:US
Mailing Address - Phone:313-690-6903
Mailing Address - Fax:
Practice Address - Street 1:2543 BLANCHE ST
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1913
Practice Address - Country:US
Practice Address - Phone:313-690-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011010441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical