Individual
MIRNA ISHAQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8175 MOVIE DR, BRIGHTON, MI 48116-7444
(248) 277-3005
(810) 206-1561
Mailing address
8175 MOVIE DR, BRIGHTON, MI 48116-7444
(248) 277-3005
(810) 206-1561
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401001813
MI
Other
Enumeration date
05/14/2019
Last updated
06/06/2022
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