Healthcare Provider Details

I. General information

NPI: 1417751330
Provider Name (Legal Business Name): MARIAM JABBIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14738 MCKNEW RD
BURTONSVILLE MD
20866-1357
US

IV. Provider business mailing address

14738 MCKNEW RD
BURTONSVILLE MD
20866-1357
US

V. Phone/Fax

Practice location:
  • Phone: 240-938-7460
  • Fax:
Mailing address:
  • Phone: 240-938-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21481
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: