Provider Demographics
NPI:1639477359
Name:JOB, MARIA ELENA (CADC)
Entity Type:Individual
Prefix:
First Name:MARIA ELENA
Middle Name:
Last Name:JOB
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CACTUS BLOOM LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1234
Mailing Address - Country:US
Mailing Address - Phone:702-630-6047
Mailing Address - Fax:
Practice Address - Street 1:601 CACTUS BLOOM LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1234
Practice Address - Country:US
Practice Address - Phone:702-630-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00640-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)