Healthcare Provider Details

I. General information

NPI: 1043078397
Provider Name (Legal Business Name): AHMAD NAWEED AHMADZAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 YAKIMA AVE
TACOMA WA
98405-4864
US

IV. Provider business mailing address

8945 GOLF LINKS RD
OAKLAND CA
94605-4124
US

V. Phone/Fax

Practice location:
  • Phone: 206-948-0096
  • Fax:
Mailing address:
  • Phone: 510-654-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC.70101231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: