Provider Demographics
NPI:1568086403
Name:TARAWALIE, KADIATU (MA,LPC,NCC)
Entity Type:Individual
Prefix:MS
First Name:KADIATU
Middle Name:
Last Name:TARAWALIE
Suffix:
Gender:F
Credentials:MA,LPC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 PARKSIDE AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2619
Mailing Address - Country:US
Mailing Address - Phone:609-248-0291
Mailing Address - Fax:
Practice Address - Street 1:1501 PARKSIDE AVE APT 3G
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-2619
Practice Address - Country:US
Practice Address - Phone:609-248-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-06
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00675800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty