Doctor Name: | MRS. JACQUELINE ANNE KABA |
NPI Number: | 1104160837 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMSW |
License Number: | 6801082363 |
Business Practice Address: | 9045 Kinloch Redford, MI - 482391885 |
Business Phone Number: | 6464920629 |
Business Fax Number: | |
Mailing Address: | 9045 Kinloch, REDFORD |
State: | MI |
Postal Code: | 482391885 |
Phone Number: | 6464920629 |
Fax Number: | |
NPI Enumeration Date: | 11/19/2012 |
NPI Last Update Date: | 05/30/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 6801082363 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |