Provider Demographics
NPI:1871000273
Name:FAHIE, KHALIL G
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:G
Last Name:FAHIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W SIDE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3029
Mailing Address - Country:US
Mailing Address - Phone:301-260-5492
Mailing Address - Fax:
Practice Address - Street 1:137 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-5400
Practice Address - Country:US
Practice Address - Phone:410-979-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-15-07515106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician