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General NPI Number Information
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NPI Number | 1265766596
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Entity Type | Individual
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Provider Name | NOCEBA MBANGATA
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Gender | Female
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 550 VANDALIA ST
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City | SAINT PAUL
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State | MN
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Zip | 55114-1833
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Country | US
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Telephone | 612-414-4730
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Fax |
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Provider Business Mailing Address
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Address Line | 2951 VANDERBIE ST
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City | LITTLE CANADA
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State | MN
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Zip | 55117-1226
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Country | US
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Telephone | 651-274-0018
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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