Provider Demographics
NPI:1477946564
Name:ENAM, ASHA DJANET
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:DJANET
Last Name:ENAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3501 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4255
Mailing Address - Country:US
Mailing Address - Phone:510-926-2927
Mailing Address - Fax:510-658-3648
Practice Address - Street 1:3501 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4255
Practice Address - Country:US
Practice Address - Phone:510-926-2927
Practice Address - Fax:510-658-3648
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health