Provider Demographics
NPI:1922708577
Name:ABDULRAHMAN, IDRIS
Entity Type:Individual
Prefix:
First Name:IDRIS
Middle Name:
Last Name:ABDULRAHMAN
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 1:701 E FRANKLIN ST STE 105-1053
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2512
Mailing Address - Country:US
Mailing Address - Phone:804-603-1008
Mailing Address - Fax:
Practice Address - Street 1:701 E FRANKLIN ST STE 105-1053
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2512
Practice Address - Country:US
Practice Address - Phone:804-603-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11507409101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health