Healthcare Provider Details

I. General information

NPI: 1336523372
Provider Name (Legal Business Name): ELISA DAKIWAG MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 7TH AVE STE 150
SANTA CRUZ CA
95062-4669
US

IV. Provider business mailing address

707 FAIR AVE
SANTA CRUZ CA
95060-5828
US

V. Phone/Fax

Practice location:
  • Phone: 831-462-1060
  • Fax: 831-462-4970
Mailing address:
  • Phone: 650-465-5747
  • Fax: 831-462-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number103978
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: