Provider Demographics
NPI:1326560897
Name:ALI, HADEEL AMJAD (PHD)
Entity Type:Individual
Prefix:DR
First Name:HADEEL
Middle Name:AMJAD
Last Name:ALI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 MOONCOIN WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6163
Mailing Address - Country:US
Mailing Address - Phone:606-224-7661
Mailing Address - Fax:
Practice Address - Street 1:3967 MOONCOIN WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6163
Practice Address - Country:US
Practice Address - Phone:606-224-7661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288911103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling