Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1558730002 |
---|---|
Provider Name | Naketa Nichelle Prewitt |
First Address | Susanville, CA 96130-4735 |
Second Address | Sparks, NV 89431-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2015 |
Last Update Date | 15/09/2015 |