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1902290687
OMAR SHABAZZ
DETROIT, MI
NPI
1902290687
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2015-03-20
Last Update Date
2015-03-20
Business Address
-- OMAR SHABAZZ
300 W MCNICHOLS RD
DETROIT, MI 48203-2703
Phone number: 313-867-8015
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Mailing Address
-- OMAR SHABAZZ
5250 BEDFORD ST
DETROIT, MI 48224-2653
Phone number: 313-808-4132
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