Provider Demographics
NPI:1558078659
Name:NDOMB, JUANITA CLAUDETTE
Entity Type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:CLAUDETTE
Last Name:NDOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:CLAUDETTE
Other - Last Name:NDOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JUANITA JOHNSON
Mailing Address - Street 1:1653 SAWTOOTH TRL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-6821
Mailing Address - Country:US
Mailing Address - Phone:321-698-5439
Mailing Address - Fax:
Practice Address - Street 1:1000 BIBLE WAY STE 59
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2133
Practice Address - Country:US
Practice Address - Phone:775-771-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health