Provider Demographics
NPI:1053056895
Name:AZZABI, MARIAN JOY (LADC)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:JOY
Last Name:AZZABI
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 GRAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2749
Mailing Address - Country:US
Mailing Address - Phone:218-207-2130
Mailing Address - Fax:218-600-5485
Practice Address - Street 1:4615 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2749
Practice Address - Country:US
Practice Address - Phone:218-207-2130
Practice Address - Fax:218-600-5485
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)