Organization
BLAQ THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTER ABDALLAH (CREDENTIALER)
(734) 802-7667
Entity
Organization
Contact information
Practice address
24073 CRESCENT ST, MATTAWAN, MI 49071-8457
(734) 802-7667
Mailing address
PO BOX 714, MATTAWAN, MI 49071-0714
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
2084P0800X
Psychiatry Physician
—
—
221700000X
Art Therapist
—
—
225A00000X
Music Therapist
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Enumeration date
01/04/2024
Last updated
01/04/2024
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