Provider Demographics
NPI:1043411143
Name:NINO, ALBA
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:
Last Name:NINO
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 1:1840 LAMONT ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2604
Mailing Address - Country:US
Mailing Address - Phone:301-219-2921
Mailing Address - Fax:
Practice Address - Street 1:8737 COLESVILLE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-7901
Practice Address - Country:US
Practice Address - Phone:301-588-8881
Practice Address - Fax:301-588-8880
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGM029Medicare ID - Type UnspecifiedLG