Provider Demographics
NPI:1629547583
Name:AFALAVA, AIGALESALA
Entity Type:Individual
Prefix:
First Name:AIGALESALA
Middle Name:
Last Name:AFALAVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23503 SE 282ND PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-8183
Mailing Address - Country:US
Mailing Address - Phone:254-383-9736
Mailing Address - Fax:
Practice Address - Street 1:22815 SE 216TH WAY
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8459
Practice Address - Country:US
Practice Address - Phone:425-358-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health