Provider Demographics
NPI:1821632522
Name:SIDDIQ, ABDUR (LICENSE SOCIAL WORKE)
Entity Type:Individual
Prefix:
First Name:ABDUR
Middle Name:
Last Name:SIDDIQ
Suffix:
Gender:M
Credentials:LICENSE SOCIAL WORKE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:BRICE
Mailing Address - State:OH
Mailing Address - Zip Code:43109-0583
Mailing Address - Country:US
Mailing Address - Phone:614-354-7006
Mailing Address - Fax:
Practice Address - Street 1:5465 ARGO LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-5402
Practice Address - Country:US
Practice Address - Phone:614-354-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1303293104100000X
OHI.2002498104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker