Provider Demographics
NPI:1386880532
Name:ALI, NAILAH M
Entity type:Individual
Prefix:
First Name:NAILAH
Middle Name:M
Last Name:ALI
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 1:412 HALLIWELL ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1521
Mailing Address - Country:US
Mailing Address - Phone:704-492-9046
Mailing Address - Fax:
Practice Address - Street 1:412 HALLIWELL ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1521
Practice Address - Country:US
Practice Address - Phone:704-492-9046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health