Provider Demographics
NPI:1063625770
Name:ARQUETTE, NANSEA L C (LCSW)
Entity type:Individual
Prefix:
First Name:NANSEA
Middle Name:L C
Last Name:ARQUETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANSEA
Other - Middle Name:LYNN
Other - Last Name:CLARK-ARQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:19160 HILLSDALE DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9205
Mailing Address - Country:US
Mailing Address - Phone:209-533-9139
Mailing Address - Fax:209-532-9002
Practice Address - Street 1:591 SOUTH WASHINGTON STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-532-9001
Practice Address - Fax:209-532-9002
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS16978101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical