Individual
BILLIE SHABAZZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
421 FALLSWAY, BALTIMORE, MD 21202-4800
(443) 703-1365
Mailing address
421 FALLSWAY, BALTIMORE, MD 21202-4800
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
22128
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
383841200
—
MD
Enumeration date
11/08/2016
Last updated
11/08/2016
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