Provider Demographics
NPI:1760041727
Name:NODINE, ANA MARIA CHARITY
Entity Type:Individual
Prefix:
First Name:ANA MARIA
Middle Name:CHARITY
Last Name:NODINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANA MARIA
Other - Middle Name:CHARITY
Other - Last Name:NODINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERTIFIED SPECIAL ED
Mailing Address - Street 1:21600 OXNARD ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7807
Mailing Address - Country:US
Mailing Address - Phone:225-439-2439
Mailing Address - Fax:
Practice Address - Street 1:230 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4725
Practice Address - Country:US
Practice Address - Phone:225-349-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician