Individual
INTITHAR ALISSAWI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23527 FORD RD, DEARBORN, MI 48128-1260
(313) 633-0364
Mailing address
41774 W VILLAGE GREEN BLVD APT 206, CANTON, MI 48187-3879
(313) 759-1507
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401001365
MI
106S00000X
Behavior Technician
—
—
374700000X
Technician
—
—
Other
Enumeration date
09/07/2017
Last updated
04/19/2021
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