Provider Demographics
NPI:1396006169
Name:ELSTON, SHAUNDRIQUES VONTAE (MHA)
Entity Type:Individual
Prefix:MS
First Name:SHAUNDRIQUES
Middle Name:VONTAE
Last Name:ELSTON
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5740 RALSTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6051
Mailing Address - Country:US
Mailing Address - Phone:805-289-3203
Mailing Address - Fax:805-289-3202
Practice Address - Street 1:5740 RALSTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6051
Practice Address - Country:US
Practice Address - Phone:805-289-3203
Practice Address - Fax:805-289-3202
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health