Provider Demographics
NPI:1316239353
Name:SHABAZZ, SHAKIRAH JOWHARAH (MS,CRC,LPC)
Entity type:Individual
Prefix:MS
First Name:SHAKIRAH
Middle Name:JOWHARAH
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:MS,CRC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 STONEY GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6246
Mailing Address - Country:US
Mailing Address - Phone:336-762-2535
Mailing Address - Fax:
Practice Address - Street 1:644 STONEY GLEN CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-6246
Practice Address - Country:US
Practice Address - Phone:336-762-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7901101YM0800X, 101YP2500X, 101Y00000X, 101YA0400X
171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901Medicaid