Provider Demographics
NPI:1922554948
Name:NODALO, PA XIONG (CADC III, APCC)
Entity Type:Individual
Prefix:
First Name:PA
Middle Name:XIONG
Last Name:NODALO
Suffix:
Gender:F
Credentials:CADC III, APCC
Other - Prefix:
Other - First Name:PA
Other - Middle Name:
Other - Last Name:XIONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC III, APCC
Mailing Address - Street 1:13586 QUIET HILLS DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5257
Mailing Address - Country:US
Mailing Address - Phone:651-786-9033
Mailing Address - Fax:
Practice Address - Street 1:3002 ARMSTRONG ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5702
Practice Address - Country:US
Practice Address - Phone:858-277-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC040351216101YA0400X
CA8339101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health