Healthcare Provider Details

I. General information

NPI: 1689322497
Provider Name (Legal Business Name): BRITTANY GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 AUBURN BLVD STE E
SACRAMENTO CA
95841-4139
US

IV. Provider business mailing address

PO BOX 581585
ELK GROVE CA
95758-0027
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-5763
  • Fax:
Mailing address:
  • Phone: 510-695-1416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: