Provider Demographics
NPI:1740879709
Name:NETTLES-TUTWILER, WONDELYN (DRUG AND ALCOHOL)
Entity type:Individual
Prefix:
First Name:WONDELYN
Middle Name:
Last Name:NETTLES-TUTWILER
Suffix:
Gender:F
Credentials:DRUG AND ALCOHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 POTRERO AVE BLDG 90
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2859
Mailing Address - Country:US
Mailing Address - Phone:628-206-3433
Mailing Address - Fax:628-206-4153
Practice Address - Street 1:995 POTRERO AVE BLDG 90
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2859
Practice Address - Country:US
Practice Address - Phone:628-206-3433
Practice Address - Fax:628-206-4153
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9136101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)