Basic Information
| Provider Information | |||||||||
| NPI: | 1659643500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLIOTT | ||||||||
| FirstName: | TONIA | ||||||||
| MiddleName: | NICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 ROLAND WAY STE 150 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946212027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108393800 | ||||||||
| FaxNumber: | 5108393888 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 ROLAND WAY STE 150 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946212027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108393800 | ||||||||
| FaxNumber: | 5108393888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2012 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.