Provider Demographics
NPI:1073031472
Name:BELOSHAPKO, ANASTASIA (ASW)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:BELOSHAPKO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 S HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-3509
Mailing Address - Country:US
Mailing Address - Phone:707-459-9900
Mailing Address - Fax:
Practice Address - Street 1:99 S HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-3509
Practice Address - Country:US
Practice Address - Phone:707-459-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 104100000X
CA78727101YM0800X, 1041C0700X
CA966421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker