Healthcare Provider Details

I. General information

NPI: 1982989950
Provider Name (Legal Business Name): MALIK SALAAM MUHAMMAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 GUY WALKER WAY
DURHAM NC
27703
US

IV. Provider business mailing address

405 GUY WALKER WAY
DURHAM NC
27703-3788
US

V. Phone/Fax

Practice location:
  • Phone: 800-984-3167
  • Fax:
Mailing address:
  • Phone: 800-984-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4091
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4438
License Number StateNC

VIII. Authorized Official

Name: DR. MALIK MUHAMMAD
Title or Position: OWNER
Credential:
Phone: 619-218-4637