Individual
OMAR SHABAZZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 W MCNICHOLS RD, DETROIT, MI 48203-2703
(313) 867-8015
(313) 867-8040
Mailing address
5250 BEDFORD ST, DETROIT, MI 48224-2653
(313) 808-4132
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/20/2015
Last updated
03/20/2015
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