Provider Demographics
NPI:1801412747
Name:HASSAN, NADIYAH ANJAIL
Entity Type:Individual
Prefix:MISS
First Name:NADIYAH
Middle Name:ANJAIL
Last Name:HASSAN
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 1:195 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-0978
Mailing Address - Country:US
Mailing Address - Phone:470-309-4820
Mailing Address - Fax:
Practice Address - Street 1:195 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-0978
Practice Address - Country:US
Practice Address - Phone:470-309-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-117441106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician