Provider Demographics
NPI:1568005189
Name:NOMPONE, MALIA CHRISTINE (LPC)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:CHRISTINE
Last Name:NOMPONE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MORNING DEW CT
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0376
Mailing Address - Country:US
Mailing Address - Phone:214-709-6336
Mailing Address - Fax:
Practice Address - Street 1:205 S BALLARD AVE
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3640
Practice Address - Country:US
Practice Address - Phone:469-757-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62160101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional