Provider Demographics
NPI:1760286579
Name:DIALLO, MAIMOUNA KALAN (BT)
Entity type:Individual
Prefix:
First Name:MAIMOUNA
Middle Name:KALAN
Last Name:DIALLO
Suffix:
Gender:
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 BINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2783
Mailing Address - Country:US
Mailing Address - Phone:313-742-2858
Mailing Address - Fax:
Practice Address - Street 1:8040 BINGHAM ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2783
Practice Address - Country:US
Practice Address - Phone:313-742-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician