Provider Demographics
NPI:1710400288
Name:NDANYI-WINBUSH, LINET NAVAYE (STUDENT)
Entity Type:Individual
Prefix:
First Name:LINET
Middle Name:NAVAYE
Last Name:NDANYI-WINBUSH
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8344 CABOCHON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-8152
Mailing Address - Country:US
Mailing Address - Phone:209-914-3301
Mailing Address - Fax:
Practice Address - Street 1:5445 LAUREL HILLS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3105
Practice Address - Country:US
Practice Address - Phone:916-609-5100
Practice Address - Fax:916-609-5160
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF102124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist