Provider Demographics
NPI:1972550325
Name:BATTLE, AQILAH TALIB (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:AQILAH
Middle Name:TALIB
Last Name:BATTLE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-4932
Mailing Address - Country:US
Mailing Address - Phone:252-522-9800
Mailing Address - Fax:252-523-9790
Practice Address - Street 1:107 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4933
Practice Address - Country:US
Practice Address - Phone:252-522-9800
Practice Address - Fax:252-523-9790
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0013411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1025UOtherBCBSNC
NC6002063Medicaid
NC2873441BMedicare PIN