Provider Demographics
NPI:1265039481
Name:DIALLO, AMINATA
Entity Type:Individual
Prefix:
First Name:AMINATA
Middle Name:
Last Name:DIALLO
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 1:8200 PROFESSIONAL PL STE 115
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2293
Mailing Address - Country:US
Mailing Address - Phone:240-297-3550
Mailing Address - Fax:
Practice Address - Street 1:8200 PROFESSIONAL PL STE 115
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2293
Practice Address - Country:US
Practice Address - Phone:240-297-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician