Provider Demographics
NPI:1861985418
Name:IBRAHIM, JUSTIN P (LICSW, MSW)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:P
Last Name:IBRAHIM
Suffix:
Gender:M
Credentials:LICSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 SW TRENTON ST # 1011
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3206
Mailing Address - Country:US
Mailing Address - Phone:425-477-9777
Mailing Address - Fax:
Practice Address - Street 1:7216 S RYAN ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-2618
Practice Address - Country:US
Practice Address - Phone:425-477-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61172478101Y00000X
WALW615331801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor