Healthcare Provider Details

I. General information

NPI: 1912018771
Provider Name (Legal Business Name): MRS. SHARON BLEVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6147 SUTTER AVE
CARMICHAEL CA
95608-2738
US

IV. Provider business mailing address

1501 GERRY WAY
ROSEVILLE CA
95661-3415
US

V. Phone/Fax

Practice location:
  • Phone: 916-971-7640
  • Fax:
Mailing address:
  • Phone: 916-786-8908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number51451 MFT INTERN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: