Provider Demographics
NPI:1912747551
Name:OFFORD NESBITT, TANECIA NICOLE
Entity type:Individual
Prefix:MRS
First Name:TANECIA
Middle Name:NICOLE
Last Name:OFFORD NESBITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 INDUSTRIAL BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3496
Mailing Address - Country:US
Mailing Address - Phone:313-646-5495
Mailing Address - Fax:
Practice Address - Street 1:3960 INDUSTRIAL BLVD STE 600
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3496
Practice Address - Country:US
Practice Address - Phone:916-752-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist