Provider Demographics
NPI:1063784213
Name:STILLS, NADIRAH S (MFT)
Entity type:Individual
Prefix:MRS
First Name:NADIRAH
Middle Name:S
Last Name:STILLS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 34TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2815
Mailing Address - Country:US
Mailing Address - Phone:510-393-8340
Mailing Address - Fax:510-225-3961
Practice Address - Street 1:465 34TH ST STE B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-393-8340
Practice Address - Fax:510-225-3961
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43629106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist