Provider Demographics
NPI:1225208374
Name:DAKHARI PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:DAKHARI PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:ONI ZAHRA
Authorized Official - Last Name:DAKHARI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:856-796-3392
Mailing Address - Street 1:128 BORTONS LANDING RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3011
Mailing Address - Country:US
Mailing Address - Phone:856-796-3392
Mailing Address - Fax:
Practice Address - Street 1:128 BORTONS LANDING RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3011
Practice Address - Country:US
Practice Address - Phone:856-796-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25S100448100103TC0700X
DEB10000736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty