Provider Demographics
NPI:1467175844
Name:NDIP, NADINE EFETI (PHD, LP)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:EFETI
Last Name:NDIP
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 ROBIN WAY
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-1666
Mailing Address - Country:US
Mailing Address - Phone:832-928-0651
Mailing Address - Fax:
Practice Address - Street 1:4600 GREENVILLE AVE STE 252
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5037
Practice Address - Country:US
Practice Address - Phone:214-618-8402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist