Provider Demographics
NPI:1114541034
Name:SHABAZZ, BAHIYAH MALIKA
Entity Type:Individual
Prefix:
First Name:BAHIYAH
Middle Name:MALIKA
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 S CHARLES ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4240
Mailing Address - Country:US
Mailing Address - Phone:912-656-8402
Mailing Address - Fax:
Practice Address - Street 1:1124 S CHARLES ST UNIT 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4240
Practice Address - Country:US
Practice Address - Phone:912-656-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty