Provider Demographics
NPI:1932230653
Name:WALEED, JALA AKILAH (CADC II, QMHA)
Entity Type:Individual
Prefix:MS
First Name:JALA
Middle Name:AKILAH
Last Name:WALEED
Suffix:
Gender:F
Credentials:CADC II, QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8525 NE GOING PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4859
Mailing Address - Country:US
Mailing Address - Phone:503-872-0480
Mailing Address - Fax:503-872-0481
Practice Address - Street 1:9268 SE CLINTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1456
Practice Address - Country:US
Practice Address - Phone:503-870-0480
Practice Address - Fax:503-872-0481
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1932230653Medicaid