Provider Demographics
NPI:1437719978
Name:MONDANE, CHARLEANER NICHOLE
Entity Type:Individual
Prefix:MRS
First Name:CHARLEANER
Middle Name:NICHOLE
Last Name:MONDANE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHARLEANER
Other - Middle Name:NICHOLE
Other - Last Name:TERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8910 CLAIREMONT MESA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-514-5144
Mailing Address - Fax:858-514-5195
Practice Address - Street 1:8910 CLAIREMONT MESA BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-514-5144
Practice Address - Fax:858-514-5195
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)