Provider Demographics
NPI:1780466763
Name:JOSEPH, AISHA CHANEL
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:CHANEL
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N CHURCH ST APT S1001
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3277
Mailing Address - Country:US
Mailing Address - Phone:704-242-3322
Mailing Address - Fax:
Practice Address - Street 1:620 N CHURCH ST APT S1001
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3277
Practice Address - Country:US
Practice Address - Phone:704-242-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health