Provider Demographics
NPI:1730636960
Name:NNANA, VIVIAN LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:LOUISE
Last Name:NNANA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:VIVIAN
Other - Middle Name:LOUSIE
Other - Last Name:NNANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4361 LATHAM ST STE 220
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-1767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4361 LATHAM ST STE 220
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-1767
Practice Address - Country:US
Practice Address - Phone:206-906-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X
CA1139081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20140602051601Medicaid