Provider Demographics
NPI:1558730002
Name:PREWITT, NAKETA NICHELLE
Entity Type:Individual
Prefix:
First Name:NAKETA
Middle Name:NICHELLE
Last Name:PREWITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 JOHNSTONVILLE RD SPC 53
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4735
Mailing Address - Country:US
Mailing Address - Phone:530-260-1058
Mailing Address - Fax:
Practice Address - Street 1:2435 PYRAMID WAY
Practice Address - Street 2:SUITE B
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1865
Practice Address - Country:US
Practice Address - Phone:530-260-1058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist