Provider Demographics
NPI:1033003181
Name:CALLAHAN, ANZJOLE SHUKYRA PASSIA
Entity type:Individual
Prefix:
First Name:ANZJOLE
Middle Name:SHUKYRA PASSIA
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 STONEY MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3860
Mailing Address - Country:US
Mailing Address - Phone:540-841-5482
Mailing Address - Fax:
Practice Address - Street 1:3999 8TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3734
Practice Address - Country:US
Practice Address - Phone:202-562-9170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC200002131101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional