Provider Demographics
NPI:1669800561
Name:MWANJABALA, GEORGE JASSON (CNA (QBA))
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JASSON
Last Name:MWANJABALA
Suffix:
Gender:M
Credentials:CNA (QBA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 KINGS ROW
Mailing Address - Street 2:2025 WEDEKIND RD
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-6825
Mailing Address - Country:US
Mailing Address - Phone:775-622-4798
Mailing Address - Fax:775-622-4798
Practice Address - Street 1:4051 KINGS ROW
Practice Address - Street 2:4051 KINGS ROW
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-6825
Practice Address - Country:US
Practice Address - Phone:775-622-4798
Practice Address - Fax:775-622-4798
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health