Provider Demographics
NPI:1487378410
Name:ELIZABETH, NICOLE (AMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ELIZABETH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:SHARAF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:335 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2652
Mailing Address - Country:US
Mailing Address - Phone:949-763-3910
Mailing Address - Fax:
Practice Address - Street 1:335 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2652
Practice Address - Country:US
Practice Address - Phone:949-763-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health