Provider Demographics
NPI:1417633918
Name:WISSA, NEVEEN MOBARAK
Entity Type:Individual
Prefix:MRS
First Name:NEVEEN
Middle Name:MOBARAK
Last Name:WISSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 N ROCK RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1262
Mailing Address - Country:US
Mailing Address - Phone:909-610-0523
Mailing Address - Fax:
Practice Address - Street 1:172 N ROCK RIVER DR
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1262
Practice Address - Country:US
Practice Address - Phone:213-441-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134118101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health