Provider Demographics
NPI:1447720925
Name:SILLAH, KADIJA ADIJA
Entity type:Individual
Prefix:
First Name:KADIJA
Middle Name:ADIJA
Last Name:SILLAH
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 1:1215 PINEHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4480
Mailing Address - Country:US
Mailing Address - Phone:336-825-1028
Mailing Address - Fax:
Practice Address - Street 1:1215 PINEHAVEN CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-4480
Practice Address - Country:US
Practice Address - Phone:336-825-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician