Provider Demographics
NPI:1871035196
Name:DIRUL-ISLAM-JOHNSON, NAFEESA HATSHEPSUT (LPC)
Entity Type:Individual
Prefix:
First Name:NAFEESA
Middle Name:HATSHEPSUT
Last Name:DIRUL-ISLAM-JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26951 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4712
Mailing Address - Country:US
Mailing Address - Phone:313-207-5079
Mailing Address - Fax:
Practice Address - Street 1:707 W MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2943
Practice Address - Country:US
Practice Address - Phone:313-595-8471
Practice Address - Fax:313-989-9525
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010157101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional