Provider Demographics
NPI:1992128441
Name:NYJAH, YAASMEEN RHETT (CRETIFIED PARENT SUP)
Entity type:Individual
Prefix:
First Name:YAASMEEN
Middle Name:RHETT
Last Name:NYJAH
Suffix:
Gender:F
Credentials:CRETIFIED PARENT SUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 LAWRENCEVILLE HWY NW UNIT 2144
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30048-4985
Mailing Address - Country:US
Mailing Address - Phone:470-296-0177
Mailing Address - Fax:
Practice Address - Street 1:4370 LAWRENCEVILLE HWY NW UNIT 2144
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30048-4985
Practice Address - Country:US
Practice Address - Phone:470-296-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health