Provider Demographics
NPI:1972121374
Name:NORMAN, KHALIAH (RADT)
Entity Type:Individual
Prefix:
First Name:KHALIAH
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3767 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-2506
Mailing Address - Country:US
Mailing Address - Phone:619-278-0777
Mailing Address - Fax:
Practice Address - Street 1:3767 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-2506
Practice Address - Country:US
Practice Address - Phone:619-278-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty