Provider Demographics
NPI:1053023341
Name:THOMAS, NANDI NZINGHA NAOMI (PLADC)
Entity type:Individual
Prefix:
First Name:NANDI
Middle Name:NZINGHA NAOMI
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8104 S 87TH ST APT A22
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3316
Mailing Address - Country:US
Mailing Address - Phone:531-777-5643
Mailing Address - Fax:
Practice Address - Street 1:112 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-5201
Practice Address - Country:US
Practice Address - Phone:402-257-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1797101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty