Provider Demographics
NPI:1831750447
Name:SHABAZZ, MENSIMAH (PHD)
Entity type:Individual
Prefix:MS
First Name:MENSIMAH
Middle Name:
Last Name:SHABAZZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AGAPE CONSULTING
Mailing Address - Street 2:383 SILAS DEANE HIGHWAY
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109
Mailing Address - Country:US
Mailing Address - Phone:860-944-6218
Mailing Address - Fax:
Practice Address - Street 1:383 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2133
Practice Address - Country:US
Practice Address - Phone:860-944-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral