Individual
ADIVA ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19251 MACK AVE STE M450, GROSSE POINTE WOODS, MI 48236-2893
(313) 343-1370
(248) 712-0438
Mailing address
19251 MACK AVE STE M450, GROSSE POINTE WOODS, MI 48236-2893
(313) 343-1370
(248) 712-0438
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/03/2025
Last updated
06/03/2025
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