Provider Demographics
NPI:1689735052
Name:KASHLAKEVA, NADIA GEORGE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:NADIA
Middle Name:GEORGE
Last Name:KASHLAKEVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 JEFFREY DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1268
Mailing Address - Country:US
Mailing Address - Phone:805-788-0307
Mailing Address - Fax:
Practice Address - Street 1:1025 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3623
Practice Address - Country:US
Practice Address - Phone:805-440-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist