Provider Demographics
NPI:1841526522
Name:ALI, BALQIS TASLEEM
Entity type:Individual
Prefix:
First Name:BALQIS
Middle Name:TASLEEM
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 1:115 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9199
Mailing Address - Country:US
Mailing Address - Phone:336-510-9785
Mailing Address - Fax:
Practice Address - Street 1:115 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9199
Practice Address - Country:US
Practice Address - Phone:336-510-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health