Individual
MS. ADRIENNE MARIE SHABAZZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBSW
Contact information
Practice address
10129 S RACE ST, FT WORTH, TX 76140-9417
(817) 789-0116
Mailing address
PO BOX 8212, FORT WORTH, TX 76124-0212
(817) 789-0116
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
25692
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
TX
Enumeration date
01/19/2008
Last updated
04/21/2023
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