Provider Demographics
NPI:1316183775
Name:NKONGHO, NDIYA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NDIYA
Middle Name:
Last Name:NKONGHO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 SHERIDAN RD NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3714
Mailing Address - Country:US
Mailing Address - Phone:404-325-8512
Mailing Address - Fax:404-325-8733
Practice Address - Street 1:1145 SHERIDAN RD NE
Practice Address - Street 2:SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3714
Practice Address - Country:US
Practice Address - Phone:404-325-8512
Practice Address - Fax:404-325-8733
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017372103TC0700X
GA3297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical