Provider Demographics
NPI:1730131459
Name:MICHELOTTI, ELIZABETH DIANE (CADCII, CCS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:MICHELOTTI
Suffix:
Gender:F
Credentials:CADCII, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-5220
Mailing Address - Country:US
Mailing Address - Phone:916-448-2951
Mailing Address - Fax:916-448-8949
Practice Address - Street 1:7000 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1865
Practice Address - Country:US
Practice Address - Phone:916-395-3552
Practice Address - Fax:916-395-3683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340084BN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)