Provider Demographics
NPI:1457041691
Name:MAY, KIAJAH AISHAH (QMHP-A/C)
Entity Type:Individual
Prefix:
First Name:KIAJAH
Middle Name:AISHAH
Last Name:MAY
Suffix:
Gender:F
Credentials:QMHP-A/C
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHP-A & QMHP-C
Mailing Address - Street 1:115 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4279
Mailing Address - Country:US
Mailing Address - Phone:434-294-5601
Mailing Address - Fax:
Practice Address - Street 1:115 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4279
Practice Address - Country:US
Practice Address - Phone:434-294-5601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No172V00000XOther Service ProvidersCommunity Health Worker