Healthcare Provider Details

I. General information

NPI: 1003742636
Provider Name (Legal Business Name): SARAH FAIRBANKS ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 VIRGINIA ST STE A
GRIDLEY CA
95948-2133
US

IV. Provider business mailing address

170 PARSON LN
OROVILLE CA
95966-9541
US

V. Phone/Fax

Practice location:
  • Phone: 530-846-4955
  • Fax:
Mailing address:
  • Phone: 530-403-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW124267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: