Provider Demographics
NPI:1043844160
Name:FAHIE, SHAMARIA A (LICSW)
Entity Type:Individual
Prefix:
First Name:SHAMARIA
Middle Name:A
Last Name:FAHIE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18204 WILLOW CREEK WAY APT G
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-0427
Mailing Address - Country:US
Mailing Address - Phone:619-597-9512
Mailing Address - Fax:
Practice Address - Street 1:18204 WILLOW CREEK WAY APT G
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0427
Practice Address - Country:US
Practice Address - Phone:619-597-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500821901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical