Shakirah Jowharah Shabazz, MS,CRC,LPC

Primary specialty

ContractorTaxonomy code 171W00000X

Practice address

644 Stoney Glen Cir
Winston Salem, NC 27107-6246

Phone

(336) 762-2535

NPI assigned

May 10, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703548800000",
    "number": "1316239353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 STONEY GLEN CIR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271076246",
            "telephone_number": "336-762-2535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 STONEY GLEN CIR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271076246",
            "telephone_number": "336-762-2535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHABAZZ",
        "first_name": "SHAKIRAH",
        "middle_name": "JOWHARAH",
        "name_prefix": "Ms.",
        "credential": "MS,CRC,LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-05-10",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "7901",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "7901",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NC",
            "license": "7901",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "7901",
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7901",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria-Dorina Cruz Sevilla, M.D.
• James Andrew Sewell, LCMHC
• Barbara Webb Sexton, LCAS-A
• Andrew Seymore, M.D.
• Ahmad Hisham Mohammad Shaban, MD
• Sarah Shabih, MD
• Judy Denise Shackett
• Brian Shackleford, MD
• Victoria Rose Shada, MD
• Millicent Johnson Shadden, LCSW

• Contractor in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Contractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.