Provider Demographics
NPI:1093198137
Name:BEYAH, ISLAH (MA, CADCII, MAC)
Entity type:Individual
Prefix:
First Name:ISLAH
Middle Name:
Last Name:BEYAH
Suffix:
Gender:F
Credentials:MA, CADCII, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MARION PL NE UNIT 605
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2790
Mailing Address - Country:US
Mailing Address - Phone:404-734-8376
Mailing Address - Fax:770-284-1988
Practice Address - Street 1:50 SEYMOUR ST
Practice Address - Street 2:UNIT 7
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-4303
Practice Address - Country:US
Practice Address - Phone:404-734-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GA101YP2500X
GA314101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty