Individual
GLORIOUS ALI SHABAZZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 E 29TH ST, PATERSON, NJ 07514-1818
(973) 930-0044
Mailing address
300 E 29TH ST, PATERSON, NJ 07514-1818
(973) 930-0044
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00280000
NJ
Other
Enumeration date
02/03/2020
Last updated
02/03/2020
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