Provider Demographics
NPI:1841591302
Name:NETTLES, ELIZABETH F
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:F
Last Name:NETTLES
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 1:3447 REDWOOD CT APT B
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5841
Mailing Address - Country:US
Mailing Address - Phone:510-706-4828
Mailing Address - Fax:
Practice Address - Street 1:3447 REDWOOD CT APT B
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5841
Practice Address - Country:US
Practice Address - Phone:510-706-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health