# NIDAA LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** NIDAA BEHAVIORAL HEALTH
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588324438
- **Authorized official:** MRS. NGOZIKA VIVIAN AMENE (ADMINISTRATOR)
- **Authorized official phone:** (480) 799-4806

## Contact information

- **Practice address:** 15850 N 35TH AVE STE 1, PHOENIX, AZ 85053-3885
- **Practice address phone:** (480) 799-4806
- **Mailing address:** 15850 N 35TH AVE STE 1, PHOENIX, AZ 85053-3885
- **Mailing address phone:** (480) 799-4806

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2021
- **Last updated:** 09/16/2024