Provider Demographics
NPI:1639231871
Name:HADDADIN, KHAILA MAJED (MFTI)
Entity Type:Individual
Prefix:
First Name:KHAILA
Middle Name:MAJED
Last Name:HADDADIN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:KHAILA
Other - Middle Name:MAJED
Other - Last Name:ABBASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3800 COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3311
Mailing Address - Country:US
Mailing Address - Phone:510-773-7076
Mailing Address - Fax:510-530-2047
Practice Address - Street 1:3800 COOLIDGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-3311
Practice Address - Country:US
Practice Address - Phone:510-773-7076
Practice Address - Fax:510-530-2047
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44098106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8209OtherMEDI-CAL