Provider Demographics
NPI:1518621457
Name:ABDUL GHIAS, SHABNAM X (RBT)
Entity Type:Individual
Prefix:MRS
First Name:SHABNAM
Middle Name:
Last Name:ABDUL GHIAS
Suffix:X
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13607 CRUSADER WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6212
Mailing Address - Country:US
Mailing Address - Phone:240-781-9809
Mailing Address - Fax:
Practice Address - Street 1:649 GUILFORD AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6349
Practice Address - Country:US
Practice Address - Phone:240-651-9432
Practice Address - Fax:855-579-6758
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-21-190269106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician