Provider Demographics
NPI:1922554948
Name:NODALO, PA XIONG (LADC)
Entity type:Individual
Prefix:
First Name:PA
Middle Name:XIONG
Last Name:NODALO
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:PA
Other - Middle Name:
Other - Last Name:XIONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1250 MOORE LAKE DR E STE 152
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5135
Mailing Address - Country:US
Mailing Address - Phone:612-389-2332
Mailing Address - Fax:612-389-2338
Practice Address - Street 1:1250 MOORE LAKE DR E STE 152
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5135
Practice Address - Country:US
Practice Address - Phone:612-389-2332
Practice Address - Fax:612-389-2338
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304280101YA0400X
CA8339101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health