Provider Demographics
NPI:1780219931
Name:MURTADI, SOMIYA M
Entity Type:Individual
Prefix:
First Name:SOMIYA
Middle Name:M
Last Name:MURTADI
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 1:472 N DALEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-2076
Mailing Address - Country:US
Mailing Address - Phone:334-803-2959
Mailing Address - Fax:
Practice Address - Street 1:472 N DALEVILLE AVE
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-2076
Practice Address - Country:US
Practice Address - Phone:334-245-3367
Practice Address - Fax:334-245-0158
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALADC-941101YA0400X
ALC3426A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)