Healthcare Provider Details

I. General information

NPI: 1609902691
Provider Name (Legal Business Name): TERRY LARAINE ZICK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9719 LINCOLN VILLAGE DR 300
SACRAMENTO CA
95827-3303
US

IV. Provider business mailing address

9719 LINCOLN VILLAGE DR 300
SACRAMENTO CA
95827-3303
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-4175
  • Fax:
Mailing address:
  • Phone: 916-485-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: