Provider Demographics
NPI:1629692827
Name:ABU AITAH, JESSICA (LLMSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ABU AITAH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GALUSZKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 CORPORATE OFFICE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-5011
Mailing Address - Country:US
Mailing Address - Phone:248-250-2842
Mailing Address - Fax:
Practice Address - Street 1:1100 CORPORATE OFFICE DR STE 100
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-5011
Practice Address - Country:US
Practice Address - Phone:248-321-8341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851119033101Y00000X
MI69511190331041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical