Healthcare Provider Details

I. General information

NPI: 1811007719
Provider Name (Legal Business Name): WENDY ANDERSON RAB LCSW, MFCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9264 MADISON AVE ROLLINGWOOD OFFICE PARK
ORANGEVALE CA
95662-5858
US

IV. Provider business mailing address

9264 MADISON AVE ROLLINGWOOD OFFICE PARK
ORANGEVALE CA
95662-5858
US

V. Phone/Fax

Practice location:
  • Phone: 916-988-2824
  • Fax: 916-988-2824
Mailing address:
  • Phone: 916-988-2824
  • Fax: 916-988-2824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS 16810
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC30090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: