Provider Demographics
NPI:1619420338
Name:ALI, VIENNA (AA, BA)
Entity Type:Individual
Prefix:MRS
First Name:VIENNA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:AA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 BAWCOM ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-3402
Mailing Address - Country:US
Mailing Address - Phone:682-888-2421
Mailing Address - Fax:
Practice Address - Street 1:1006 BAWCOM ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-3402
Practice Address - Country:US
Practice Address - Phone:682-888-2421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker