Provider Demographics
NPI:1477243962
Name:HADDAD, NICOLE ARUTHA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ARUTHA
Last Name:HADDAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ARUTHA
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:819 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-2864
Mailing Address - Country:US
Mailing Address - Phone:209-214-8532
Mailing Address - Fax:
Practice Address - Street 1:819 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-2864
Practice Address - Country:US
Practice Address - Phone:209-214-8532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist