Provider Demographics
NPI:1376304410
Name:SALAZAR PETTITT, TAEVIA (MSW, PPSC)
Entity Type:Individual
Prefix:
First Name:TAEVIA
Middle Name:
Last Name:SALAZAR PETTITT
Suffix:
Gender:F
Credentials:MSW, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 J ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3055
Mailing Address - Country:US
Mailing Address - Phone:707-441-2404
Mailing Address - Fax:
Practice Address - Street 1:2100 J ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3055
Practice Address - Country:US
Practice Address - Phone:707-441-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230213980101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool