Provider Demographics
NPI:1134873557
Name:ALI, RIAHANAH (MS, TLLP)
Entity type:Individual
Prefix:
First Name:RIAHANAH
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:MS, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4659 HUNT CLUB DR APT 1A
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9077
Mailing Address - Country:US
Mailing Address - Phone:734-846-0698
Mailing Address - Fax:
Practice Address - Street 1:350 N MAIN ST STE 220
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1635
Practice Address - Country:US
Practice Address - Phone:734-433-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009355103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist