Provider Demographics
NPI:1386471746
Name:ORISHA, NOVA BLAKE
Entity type:Individual
Prefix:MISS
First Name:NOVA
Middle Name:BLAKE
Last Name:ORISHA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DASIA
Other - Middle Name:SYMONE-LENA
Other - Last Name:HANNIBAL-LITTLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6619 CHINATOWN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-8031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6771 W CHARLESTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9016
Practice Address - Country:US
Practice Address - Phone:702-405-8772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician