Healthcare Provider Details

I. General information

NPI: 1780310441
Provider Name (Legal Business Name): ALENKA MAY MUNGONYE-FAIRLEY CT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALENKA FAIRLEY

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 OHIO PIKE STE 312A
CINCINNATI OH
45255-3375
US

IV. Provider business mailing address

431 OHIO PIKE STE 312A
CINCINNATI OH
45255-3375
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-1705
  • Fax:
Mailing address:
  • Phone: 513-770-1705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2406309
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberC.2305084-TRNE
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: