Provider Demographics
NPI:1265766596
Name:MBANGATA, NOCEBA
Entity type:Individual
Prefix:
First Name:NOCEBA
Middle Name:
Last Name:MBANGATA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2951 VANDERBIE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1226
Mailing Address - Country:US
Mailing Address - Phone:651-274-0018
Mailing Address - Fax:
Practice Address - Street 1:550 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1833
Practice Address - Country:US
Practice Address - Phone:612-414-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)