Provider Demographics
NPI:1417351990
Name:POMA, ELIZABETH (MSW, CADC-I)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:POMA
Suffix:
Gender:F
Credentials:MSW, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9811 W CHARLESTON BLVD
Mailing Address - Street 2:#2626
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7528
Mailing Address - Country:US
Mailing Address - Phone:702-228-8520
Mailing Address - Fax:702-448-7205
Practice Address - Street 1:2975 S RAINBOW BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6242
Practice Address - Country:US
Practice Address - Phone:702-228-8520
Practice Address - Fax:702-448-7205
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01445-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)