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General NPI Number Information
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NPI Number | 1699164483
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Entity Type | Organization
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Legal Business Name | AMANDA S. NGOLA LCSW LLC
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Dates
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Enumeration Date | 01/15/2015
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 740 REGENT ST STE 202
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City | MADISON
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State | WI
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Zip | 53715-2649
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Country | US
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Telephone | 608-239-5071
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Fax |
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Provider Business Mailing Address
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Address Line | 740 REGENT ST STE 202
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City | MADISON
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State | WI
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Zip | 53715-2649
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Country | US
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Telephone | 608-239-5071
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | AMANDA SIMS NGOLA
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Credential | LCSW
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Telephone | 608-239-5071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6967-123
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License Number State | WI
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