Provider Demographics
NPI:1245368331
Name:NELSON, ERIC HELLAND (SAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:HELLAND
Last Name:NELSON
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-7615
Mailing Address - Country:US
Mailing Address - Phone:707-444-3166
Mailing Address - Fax:
Practice Address - Street 1:3940 CEDAR ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-7615
Practice Address - Country:US
Practice Address - Phone:707-444-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN0501021436101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)