Provider Demographics
NPI:1598223323
Name:STA'LLONE, HAJA NENEH
Entity Type:Individual
Prefix:
First Name:HAJA NENEH
Middle Name:
Last Name:STA'LLONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAJA
Other - Middle Name:
Other - Last Name:KAMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9720 CAPITAL CT STE 108
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-2049
Mailing Address - Country:US
Mailing Address - Phone:703-770-8060
Mailing Address - Fax:703-748-2212
Practice Address - Street 1:9720 CAPITAL CT.
Practice Address - Street 2:STE. 108
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3295
Practice Address - Country:US
Practice Address - Phone:703-770-8060
Practice Address - Fax:703-748-2212
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-20-43395103K00000X
VARBT-18-55706106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty