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Contact Information

MOMODOUBOLONG FAITALA
3105 LAKESHORE DR STE A101
ANCHORAGE, AK99517-2815
 Phone: 907-302-9164
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Behavior Technician

106S00000X
 

Addiction (Substance Use Disorder)

101YA0400X
Indicates primary specialty

NPI Profile & details for MOMODOUBOLONG FAITALA · (Male)

NPI Number 1144810763
Status Active
Credentials
Entity Individual
Enumeration date 01/19/2021
Last updated 12/17/2021 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • AK License # RBT-21-196652
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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