=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013309574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NDS-I, A PSYCHOLOGICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2015
-----------------------------------------------------
Last Update Date | 02/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 S GLENDALE AVE SUITE 4
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-3297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-551-1800
-----------------------------------------------------
Fax | 844-272-6210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1222 S GLENDALE AVE SUITE 4
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91205-3297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-551-1800
-----------------------------------------------------
Fax | 844-272-6210
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. NONA WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-551-1802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY20867
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------