Provider Demographics
NPI:1992989263
Name:ELLIOTT, DAVID THOMAS (LCSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:THOMAS
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 IRON POINT RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8707
Mailing Address - Country:US
Mailing Address - Phone:916-817-5826
Mailing Address - Fax:
Practice Address - Street 1:2222 WATT AVE STE D5
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0581
Practice Address - Country:US
Practice Address - Phone:916-825-0632
Practice Address - Fax:916-489-3297
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS237541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical