Healthcare Provider Details

I. General information

NPI: 1164753984
Provider Name (Legal Business Name): MARY ANNE GOODRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2010
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 N B ST STE E
SACRAMENTO CA
95811-0326
US

IV. Provider business mailing address

1103 N B ST STE E
SACRAMENTO CA
95811-0326
US

V. Phone/Fax

Practice location:
  • Phone: 916-388-9418
  • Fax: 916-388-9273
Mailing address:
  • Phone: 279-201-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: