Provider Demographics
NPI:1114438512
Name:SIDDIQI, SHAZIA (MA, LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:SHAZIA
Middle Name:
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:MA, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-7900
Mailing Address - Country:US
Mailing Address - Phone:248-210-5118
Mailing Address - Fax:
Practice Address - Street 1:36 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-2133
Practice Address - Country:US
Practice Address - Phone:248-210-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MI6401012541101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional