Healthcare Provider Details

I. General information

NPI: 1285277442
Provider Name (Legal Business Name): BRANDA JOLISA CORREA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 AUBURN BLVD
SACRAMENTO CA
95841-4139
US

IV. Provider business mailing address

1044 CUMMINS WAY
WEST SACRAMENTO CA
95605-2125
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-5764
  • Fax:
Mailing address:
  • Phone: 916-737-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: