Momodoubolong Faitala

NPI #1144810763 in Anchorage, Alaska

Provider Information

NPI Number: 1144810763
Entity Type: Individual
Name: Momodoubolong Faitala
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Jan 19, 2021
Last Updated: Dec 17, 2021

Practice Location

Address: 3105 LAKESHORE DR STE A101
City: Anchorage
State: Alaska
ZIP Code: 99517-2815
Phone: (907) 302-9164

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder)	101YA0400X
Behavior Technician	106S00000X	Primary

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