Provider Demographics
NPI:1467077305
Name:ALI, JONETHA AASIMAH (LISW)
Entity Type:Individual
Prefix:
First Name:JONETHA
Middle Name:AASIMAH
Last Name:ALI
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 LINCOLN DR APT F10
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1155
Mailing Address - Country:US
Mailing Address - Phone:216-466-3675
Mailing Address - Fax:
Practice Address - Street 1:9225 LINCOLN DR APT F10
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1155
Practice Address - Country:US
Practice Address - Phone:216-466-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.177018101YA0400X
OHI.23044991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0408612Medicaid