Healthcare Provider Details

I. General information

NPI: 1750135315
Provider Name (Legal Business Name): SANCTUARY MARRIAGE AND FAMILY THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 E BIDWELL ST STE 114
FOLSOM CA
95630-3559
US

IV. Provider business mailing address

2280 E BIDWELL ST STE 114
FOLSOM CA
95630-3559
US

V. Phone/Fax

Practice location:
  • Phone: 916-577-6223
  • Fax:
Mailing address:
  • Phone: 916-577-6223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ANN MARIE PIERCE
Title or Position: PRESIDENT
Credential: LMFT
Phone: 916-577-6223