Provider Demographics
NPI:1942843289
Name:ALAM, DAISY LAROT
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:LAROT
Last Name:ALAM
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 1:101 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-3602
Mailing Address - Country:US
Mailing Address - Phone:707-961-0172
Mailing Address - Fax:
Practice Address - Street 1:101 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3602
Practice Address - Country:US
Practice Address - Phone:707-961-0172
Practice Address - Fax:844-388-6167
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC7744103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health