Provider Demographics
NPI:1326191453
Name:ALABA-YUSOUF, CAL MELISA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CAL
Middle Name:MELISA
Last Name:ALABA-YUSOUF
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:ALABA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1660 IRONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6036
Mailing Address - Country:US
Mailing Address - Phone:404-913-4450
Mailing Address - Fax:
Practice Address - Street 1:2470 WINDY HILL RD SE
Practice Address - Street 2:SUITE 319
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8613
Practice Address - Country:US
Practice Address - Phone:404-913-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-003441101Y00000X
GALPC006654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003121613AMedicaid