Provider Demographics
NPI:1881466498
Name:DOUMBIA, KHADIJAH IMANI
Entity type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:IMANI
Last Name:DOUMBIA
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 1:25 BRAINTREE HILL OFFICE PARK
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:617-876-4626
Mailing Address - Fax:
Practice Address - Street 1:25 BRAINTREE HILL OFFICE PARK
Practice Address - Street 2:SUITE 206
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:617-876-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty