Provider Demographics
NPI:1649449398
Name:WHITTLE-DAGGETT, ELANNA (IMF 43803)
Entity type:Individual
Prefix:
First Name:ELANNA
Middle Name:
Last Name:WHITTLE-DAGGETT
Suffix:
Gender:F
Credentials:IMF 43803
Other - Prefix:
Other - First Name:ELANNA
Other - Middle Name:
Other - Last Name:WHITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 WALNUT AVE
Mailing Address - Street 2:STE. 208
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3900
Mailing Address - Country:US
Mailing Address - Phone:831-423-9444
Mailing Address - Fax:831-423-9444
Practice Address - Street 1:104 WALNUT AVE
Practice Address - Street 2:STE. 208
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3900
Practice Address - Country:US
Practice Address - Phone:831-423-9444
Practice Address - Fax:831-423-9444
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 43803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43803OtherIMF