Healthcare Provider Details

I. General information

NPI: 1356994206
Provider Name (Legal Business Name): LORETTA LORRAINE KIRBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date: 12/23/2025
Reactivation Date: 01/20/2026

III. Provider practice location address

10513 FAIR OAKS BLVD
FAIR OAKS CA
95628-7268
US

IV. Provider business mailing address

10513 FAIR OAKS BLVD
FAIR OAKS CA
95628-7268
US

V. Phone/Fax

Practice location:
  • Phone: 916-450-0892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13860
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: