Provider Demographics
NPI:1396466264
Name:ABDULBARR, TANIYAH IMANI
Entity type:Individual
Prefix:
First Name:TANIYAH
Middle Name:IMANI
Last Name:ABDULBARR
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 1:11729 CAPSTAN DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3926
Mailing Address - Country:US
Mailing Address - Phone:240-688-7932
Mailing Address - Fax:
Practice Address - Street 1:1401 MERCANTILE LN STE 423
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4301
Practice Address - Country:US
Practice Address - Phone:301-851-5954
Practice Address - Fax:301-851-5932
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13078101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health