Individual
TINA DIBOFO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
39465 W 14 MILE RD, NOVI, MI 48377-1600
(877) 906-9699
Mailing address
39465 W 14 MILE RD, NOVI, MI 48377-1600
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
209.034913
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209034913
IL
Other
Enumeration date
03/11/2026
Last updated
03/18/2026
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