Provider Demographics
NPI:1528751443
Name:COTTRELL, PATRICIA AMY (ACSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:AMY
Last Name:COTTRELL
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-1523
Mailing Address - Country:US
Mailing Address - Phone:707-396-7581
Mailing Address - Fax:
Practice Address - Street 1:508 H ST STE 6
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-3723
Practice Address - Country:US
Practice Address - Phone:707-460-0957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health