Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003187220 |
---|---|
Provider Name | Mrs. Shantel Elessie |
First Address | Pittsburgh, PA 15213-3317 |
Second Address | Pittsburgh, PA 15213-3317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2012 |
Last Update Date | 19/01/2012 |