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General NPI Number Information
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NPI Number | 1821632522
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Entity Type | Individual
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Provider Name | ABDUR SIDDIQ LICENSE SOCIAL WORKE
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Gender | Male
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 08/12/2021
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Provider Practice Location Address
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Address Line | 5465 ARGO LN
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City | COLUMBUS
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State | OH
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Zip | 43232-5402
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Country | US
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Telephone | 614-354-7006
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 583
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City | BRICE
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State | OH
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Zip | 43109-0583
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Country | US
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Telephone | 614-354-7006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1303293
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I.2002498
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License Number State | OH
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