Provider Demographics
NPI:1669846960
Name:ABDUR RAZZAQ COUNSELING & SOCIAL ARCHITECTURE, PA
Entity Type:Organization
Organization Name:ABDUR RAZZAQ COUNSELING & SOCIAL ARCHITECTURE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUR RAZZAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:651-329-6171
Mailing Address - Street 1:792 FULLER AVE
Mailing Address - Street 2:#1
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5068
Mailing Address - Country:US
Mailing Address - Phone:612-564-0433
Mailing Address - Fax:
Practice Address - Street 1:792 FULLER AVE
Practice Address - Street 2:#1
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:612-564-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health