Provider Demographics
NPI:1831771146
Name:SALEM, SHADIAH (LPC, MBA, NCC)
Entity type:Individual
Prefix:MS
First Name:SHADIAH
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:LPC, MBA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 N GARLAND AVE # 140-159
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2785
Mailing Address - Country:US
Mailing Address - Phone:972-643-8313
Mailing Address - Fax:
Practice Address - Street 1:1209 WINDING BROOK DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-2432
Practice Address - Country:US
Practice Address - Phone:972-643-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79626101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional