Provider Demographics
NPI:1295374163
Name:ACOSTA, NINA (LCSW)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2443 FAIR OAKS BLVD # 283
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-7684
Mailing Address - Country:US
Mailing Address - Phone:916-826-0789
Mailing Address - Fax:
Practice Address - Street 1:8049 JAHN RD
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-9721
Practice Address - Country:US
Practice Address - Phone:916-826-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA905261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty