Provider Demographics
NPI:1578619334
Name:ABDUR-RAZZAQ, SHELDA J (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHELDA
Middle Name:J
Last Name:ABDUR-RAZZAQ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5011 SOUTHPARK DR.
Mailing Address - Street 2:5011 SOUTHPARK DR. SU. 130
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6286
Mailing Address - Country:US
Mailing Address - Phone:919-408-7839
Mailing Address - Fax:919-361-1900
Practice Address - Street 1:5011 SOUTHPARK DR.
Practice Address - Street 2:5011 SOUTHPARK DR. SU. 130
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6286
Practice Address - Country:US
Practice Address - Phone:919-408-7839
Practice Address - Fax:919-361-1900
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102831Medicaid
NC270858OtherVALUE OPTIONS
NC10778OtherBCBS
NC274221OtherMHN