Provider Demographics
NPI:1134941305
Name:AHMED, ISHAH (MA, LLMSW)
Entity type:Individual
Prefix:
First Name:ISHAH
Middle Name:
Last Name:AHMED
Suffix:
Gender:F
Credentials:MA, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14930 LAPLAISANCE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3871
Mailing Address - Country:US
Mailing Address - Phone:734-241-0180
Mailing Address - Fax:
Practice Address - Street 1:14930 LAPLAISANCE RD STE 106
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3871
Practice Address - Country:US
Practice Address - Phone:734-241-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511177811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty