Provider Demographics
NPI:1740927755
Name:FAIMALIE, MORIAH LEIGH (MSW, LSWAIC, MHP)
Entity type:Individual
Prefix:
First Name:MORIAH
Middle Name:LEIGH
Last Name:FAIMALIE
Suffix:
Gender:F
Credentials:MSW, LSWAIC, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 WILLIAMS ST NW
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-7503
Mailing Address - Country:US
Mailing Address - Phone:206-963-3019
Mailing Address - Fax:
Practice Address - Street 1:721 WILLIAMS ST NW
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-7503
Practice Address - Country:US
Practice Address - Phone:206-963-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC.610353631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical