Provider Demographics
NPI:1811729650
Name:BILL, ELVINA ANGELICA
Entity type:Individual
Prefix:
First Name:ELVINA
Middle Name:ANGELICA
Last Name:BILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELVINA
Other - Middle Name:ANGELICA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5510
Mailing Address - Country:US
Mailing Address - Phone:707-900-2121
Mailing Address - Fax:
Practice Address - Street 1:809 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5510
Practice Address - Country:US
Practice Address - Phone:707-900-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA101YM0800X
WASC61573396104100000X
1041C0700X
CA125302104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical