Healthcare Provider Details

I. General information

NPI: 1568086403
Provider Name (Legal Business Name): KADIATU TARAWALIE MA,LPC,NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2020
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 COUNTRY LN
HAMILTON NJ
08690-3326
US

IV. Provider business mailing address

7 COUNTRY LN
TRENTON NJ
08690-3326
US

V. Phone/Fax

Practice location:
  • Phone: 732-322-2608
  • Fax:
Mailing address:
  • Phone: 732-322-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00675800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: