Provider Demographics
NPI:1992053920
Name:NOMA, NANETTE S (MA, SUDP)
Entity type:Individual
Prefix:MS
First Name:NANETTE
Middle Name:S
Last Name:NOMA
Suffix:
Gender:
Credentials:MA, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2569
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98213-0569
Mailing Address - Country:US
Mailing Address - Phone:425-212-4200
Mailing Address - Fax:425-212-4201
Practice Address - Street 1:2500 E COLLEGE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5862
Practice Address - Country:US
Practice Address - Phone:360-336-3762
Practice Address - Fax:360-336-3815
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60821276101YA0400X
FLICADC703210101YA0400X
FLCAP 4884101YA0400X
FLIMH 9806101YM0800X
WAMC61309005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)