Provider Demographics
NPI:1568809945
Name:GIRGIS, MARIHAM O (MA TLLP)
Entity Type:Individual
Prefix:
First Name:MARIHAM
Middle Name:O
Last Name:GIRGIS
Suffix:
Gender:F
Credentials:MA TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:468 FOX HILLS DR S
Mailing Address - Street 2:APT 5
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1355
Mailing Address - Country:US
Mailing Address - Phone:248-312-8478
Mailing Address - Fax:586-263-5311
Practice Address - Street 1:42621 GARFIELD RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5031
Practice Address - Country:US
Practice Address - Phone:586-263-3312
Practice Address - Fax:586-263-5311
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301015485103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling