Provider Demographics
NPI:1275067092
Name:SELF, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SELF
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 1:1451 ELM HILL PIKE
Mailing Address - Street 2:STE. 250
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-4523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3606 ROBIN RD
Practice Address - Street 2:ROBIN ROAD
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3825
Practice Address - Country:US
Practice Address - Phone:615-300-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker