Provider Demographics
NPI:1457718595
Name:KHATIB, ASSMA (LPC)
Entity Type:Individual
Prefix:
First Name:ASSMA
Middle Name:
Last Name:KHATIB
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 1:2651 SAULINO CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48120-1556
Mailing Address - Country:US
Mailing Address - Phone:313-842-7010
Mailing Address - Fax:313-842-5150
Practice Address - Street 1:6451 SCHAEFER RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2212
Practice Address - Country:US
Practice Address - Phone:313-945-8138
Practice Address - Fax:313-203-3390
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1457718595Medicaid