Provider Demographics
NPI:1689676546
Name:BABBIE-GILL, IBTISAM H (CSW)
Entity Type:Individual
Prefix:MRS
First Name:IBTISAM
Middle Name:H
Last Name:BABBIE-GILL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:MRS
Other - First Name:IBTISAM
Other - Middle Name:H
Other - Last Name:BABBIE-GAMMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CAAC
Mailing Address - Street 1:4646 JOHN R ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1916
Mailing Address - Country:US
Mailing Address - Phone:313-576-1000
Mailing Address - Fax:313-576-1074
Practice Address - Street 1:4646 JOHN R ST
Practice Address - Street 2:VAMC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1916
Practice Address - Country:US
Practice Address - Phone:313-576-1000
Practice Address - Fax:313-576-1074
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIIB0818811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical