Provider Demographics
NPI:1437527926
Name:NDOLO, CORINNA
Entity Type:Individual
Prefix:
First Name:CORINNA
Middle Name:
Last Name:NDOLO
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 1:1835 E GUADALUPE RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3277
Mailing Address - Country:US
Mailing Address - Phone:480-659-5456
Mailing Address - Fax:480-838-1828
Practice Address - Street 1:1835 E GUADALUPE RD
Practice Address - Street 2:STE. 103
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3277
Practice Address - Country:US
Practice Address - Phone:480-659-5456
Practice Address - Fax:480-838-1828
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBA-174103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst