Healthcare Provider Details

I. General information

NPI: 1952997116
Provider Name (Legal Business Name): SAVANNAH GRACE DRAGOMANOVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 PLAZA DR W
FRESNO CA
93702-1342
US

IV. Provider business mailing address

2940 N FRESNO ST
FRESNO CA
93703-1123
US

V. Phone/Fax

Practice location:
  • Phone: 559-981-1070
  • Fax:
Mailing address:
  • Phone: 559-836-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number135773
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number135773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: