Provider Demographics
NPI:1326514290
Name:HANIFZAI, WALI ABDUL (ACSW)
Entity Type:Individual
Prefix:
First Name:WALI
Middle Name:ABDUL
Last Name:HANIFZAI
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2854 N SANTIAGO BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-1700
Mailing Address - Country:US
Mailing Address - Phone:310-985-3845
Mailing Address - Fax:
Practice Address - Street 1:2854 N SANTIAGO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-1700
Practice Address - Country:US
Practice Address - Phone:310-985-3845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174H00000XOther Service ProvidersHealth Educator