Organization
NIDAA LLC
Active
Other names
NIDAA BEHAVIORAL HEALTH
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NGOZIKA VIVIAN AMENE (ADMINISTRATOR)
(480) 799-4806
Entity
Organization
Contact information
Practice address
15850 N 35TH AVE STE 1, PHOENIX, AZ 85053-3885
(480) 799-4806
Mailing address
15850 N 35TH AVE STE 1, PHOENIX, AZ 85053-3885
(480) 799-4806
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/20/2021
Last updated
09/16/2024
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