Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 162016 | OH |
N | 104100000X | Social Worker | 2106096 | OH |
Y | 1041C0700X | Clinical Social Worker | S.2106096 | OH |
NPI | 1003329228 |
---|---|
Provider Name | Fatimaah Brown-Shakir |
First Address | Mentor, OH 44060-4881 |
Second Address | Mentor, OH 44060-4881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2017 |
Last Update Date | 20/05/2021 |