Provider Demographics
NPI:1740604321
Name:NDIKA, NNENNA (PHD)
Entity Type:Individual
Prefix:
First Name:NNENNA
Middle Name:
Last Name:NDIKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 KING ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3891
Mailing Address - Country:US
Mailing Address - Phone:559-408-6237
Mailing Address - Fax:
Practice Address - Street 1:21633 AVENUE 24
Practice Address - Street 2:VALLEY STATE PRISON
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-9650
Practice Address - Country:US
Practice Address - Phone:401-874-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAUNLICENSED103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist