Provider Demographics
NPI:1205984523
Name:SALLES, ELIZABETH DIANE (CADC-II CA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:SALLES
Suffix:
Gender:F
Credentials:CADC-II CA
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:DIANE
Other - Last Name:SALLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAS II
Mailing Address - Street 1:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0087
Mailing Address - Country:US
Mailing Address - Phone:209-381-1430
Mailing Address - Fax:209-725-3505
Practice Address - Street 1:2840 W SANDY MUSH RD
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-8009
Practice Address - Country:US
Practice Address - Phone:209-381-1430
Practice Address - Fax:209-725-3505
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA020560815101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)