Provider Demographics
NPI:1336459650
Name:FRAZIER, PRISCILLA (RRW)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:FRAZIER
Suffix:
Gender:F
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 HENDERSON ST
Mailing Address - Street 2:STE C
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7374
Mailing Address - Country:US
Mailing Address - Phone:530-273-9541
Mailing Address - Fax:
Practice Address - Street 1:440 HENDERSON ST
Practice Address - Street 2:STE C
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7374
Practice Address - Country:US
Practice Address - Phone:530-273-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW3595101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)