Provider Demographics
NPI:1912548033
Name:NELSON, ELIZABETH DENISE (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DENISE
Last Name:NELSON
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-2102
Mailing Address - Country:US
Mailing Address - Phone:209-284-0970
Mailing Address - Fax:209-284-0971
Practice Address - Street 1:1405 11TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0748
Practice Address - Country:US
Practice Address - Phone:209-284-0970
Practice Address - Fax:209-284-0971
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC21131214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)