Provider Demographics
NPI:1629669650
Name:ABDALLAH, MARYAM (LMSW)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:ABDALLAH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6216 DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:WHITES CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37189-2902
Mailing Address - Country:US
Mailing Address - Phone:731-694-2839
Mailing Address - Fax:
Practice Address - Street 1:4205 HILLSBORO PIKE STE 314
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3339
Practice Address - Country:US
Practice Address - Phone:615-398-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN102141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty