Provider Demographics
NPI:1124676887
Name:BATISTE, KIA IMAN
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:IMAN
Last Name:BATISTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 TOWER CT APT 502
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3236
Mailing Address - Country:US
Mailing Address - Phone:865-805-8330
Mailing Address - Fax:
Practice Address - Street 1:2600 DOUGLASS RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6504
Practice Address - Country:US
Practice Address - Phone:202-516-7265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500829981041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool