Healthcare Provider Details

I. General information

NPI: 1073327359
Provider Name (Legal Business Name): SARAH PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12183 LOCKSLEY LN
AUBURN CA
95602-2004
US

IV. Provider business mailing address

406 SUNRISE AVE STE 100
ROSEVILLE CA
95661-4106
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-1961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1596910125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: