Individual
BEVERLY ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW 75361, CST
Contact information
Practice address
1485 WALLER STREET APT 203, SAN FRANCISCO, CA 94117
(415) 969-6886
Mailing address
584 CASTRO ST # 2094, SAN FRANCISCO, CA 94114-2512
(415) 969-6886
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
75361
CA
101Y00000X
Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
75361
CA
Other
Enumeration date
11/25/2014
Last updated
03/18/2024
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