Provider Demographics
NPI:1225892375
Name:NDIFONGWA, NGON MINANG (LICSW)
Entity Type:Individual
Prefix:
First Name:NGON
Middle Name:MINANG
Last Name:NDIFONGWA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 229N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1902
Mailing Address - Country:US
Mailing Address - Phone:512-878-1446
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 229N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1902
Practice Address - Country:US
Practice Address - Phone:651-287-8144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health