Provider Demographics
NPI:1023626488
Name:YAHYA, FOADEH ALI (LLMSW)
Entity type:Individual
Prefix:MISS
First Name:FOADEH
Middle Name:ALI
Last Name:YAHYA
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2259
Mailing Address - Country:US
Mailing Address - Phone:313-216-2238
Mailing Address - Fax:
Practice Address - Street 1:5133 SAINT LAWRENCE ST APT 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2162
Practice Address - Country:US
Practice Address - Phone:313-330-1483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011069321041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool