Provider Demographics
NPI:1164873030
Name:KAMALA, AISHA MAHINA
Entity Type:Individual
Prefix:MS
First Name:AISHA
Middle Name:MAHINA
Last Name:KAMALA
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:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-0353
Mailing Address - Country:US
Mailing Address - Phone:530-891-2986
Mailing Address - Fax:
Practice Address - Street 1:2167 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4945
Practice Address - Country:US
Practice Address - Phone:530-538-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health