Provider Demographics
NPI:1619776853
Name:KIAWU, PAUL THOMAS FATHAY
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS FATHAY
Last Name:KIAWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 GAS LIGHT CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3274
Mailing Address - Country:US
Mailing Address - Phone:301-458-9181
Mailing Address - Fax:301-458-9181
Practice Address - Street 1:31 GAS LIGHT CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3274
Practice Address - Country:US
Practice Address - Phone:301-458-9181
Practice Address - Fax:301-458-9181
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA815497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional