Individual
MS. AHLAYAH DAVIANAH SHABAZZ I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1025 ATLANTIC AVE, ALAMEDA, CA 94501-1189
(510) 268-8120
Mailing address
1025 ATLANTIC AVE, ALAMEDA, CA 94501-1189
(510) 268-8120
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
101YM0800X
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XDJ95973531E
—
CA
Enumeration date
10/12/2019
Last updated
10/12/2019
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