Provider Demographics
NPI:1851772248
Name:JAVADI, BAHAR (MA,MS,LCPC)
Entity Type:Individual
Prefix:MS
First Name:BAHAR
Middle Name:
Last Name:JAVADI
Suffix:
Gender:F
Credentials:MA,MS,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11108 BROAD GREEN DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2021
Mailing Address - Country:US
Mailing Address - Phone:301-299-2921
Mailing Address - Fax:
Practice Address - Street 1:11108 BROAD GREEN DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2021
Practice Address - Country:US
Practice Address - Phone:301-299-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6379101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD095112900Medicaid