Provider Demographics
NPI:1871031047
Name:DAFA, HABTE
Entity Type:Individual
Prefix:
First Name:HABTE
Middle Name:
Last Name:DAFA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 WINDSIDE CT.
Mailing Address - Street 2:
Mailing Address - City:ANN
Mailing Address - State:MICHIGAN
Mailing Address - Zip Code:48103
Mailing Address - Country:UM
Mailing Address - Phone:734-545-0759
Mailing Address - Fax:
Practice Address - Street 1:4925 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1521
Practice Address - Country:US
Practice Address - Phone:734-971-9781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010667261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical