Provider Demographics
NPI:1417642596
Name:TARAWALI, SORIE NECKYAN
Entity Type:Individual
Prefix:
First Name:SORIE
Middle Name:NECKYAN
Last Name:TARAWALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9789 GOOD LUCK RD APT 11
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3343
Mailing Address - Country:US
Mailing Address - Phone:240-595-8387
Mailing Address - Fax:
Practice Address - Street 1:9789 GOOD LUCK RD APT 11
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3343
Practice Address - Country:US
Practice Address - Phone:240-595-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor