Provider Demographics
NPI:1225787757
Name:MWANALITI, NIISI N (RBT)
Entity Type:Individual
Prefix:
First Name:NIISI
Middle Name:N
Last Name:MWANALITI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:NIISI
Other - Middle Name:
Other - Last Name:MWANALITI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:1321 MURFREESBORO PIKE STE 702
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-2679
Mailing Address - Country:US
Mailing Address - Phone:615-361-4000
Mailing Address - Fax:
Practice Address - Street 1:1511 JOHNSON FERRY RD STE 145
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6403
Practice Address - Country:US
Practice Address - Phone:404-480-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty