Provider Demographics
NPI:1720705346
Name:COULIBALY, MAIMOUNA (MED)
Entity Type:Individual
Prefix:
First Name:MAIMOUNA
Middle Name:
Last Name:COULIBALY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 W CHESTER PIKE APT C3E
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1328
Mailing Address - Country:US
Mailing Address - Phone:610-504-5826
Mailing Address - Fax:
Practice Address - Street 1:8115 W CHESTER PIKE APT C3E
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1328
Practice Address - Country:US
Practice Address - Phone:610-504-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty