Provider Demographics
NPI:1922329341
Name:INTERNATIONAL CONSULTANT OF HEALTH AND EDUCATIONAL PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:INTERNATIONAL CONSULTANT OF HEALTH AND EDUCATIONAL PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKA
Authorized Official - Middle Name:ABDUL
Authorized Official - Last Name:MOUSTAFA
Authorized Official - Suffix:I
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-477-7928
Mailing Address - Street 1:108 CAUGHMAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-3114
Mailing Address - Country:US
Mailing Address - Phone:803-477-7928
Mailing Address - Fax:
Practice Address - Street 1:108 CAUGHMAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-3114
Practice Address - Country:US
Practice Address - Phone:803-477-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty