Healthcare Provider Details

I. General information

NPI: 1174905467
Provider Name (Legal Business Name): TERRY HOBBS AII7641214
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7586 STOCKTON BLVD
SACRAMENTO CA
95823-3923
US

IV. Provider business mailing address

7586 STOCKTON BLVD
SACRAMENTO CA
95823-3923
US

V. Phone/Fax

Practice location:
  • Phone: 916-877-8244
  • Fax: 916-491-7411
Mailing address:
  • Phone: 916-877-8244
  • Fax: 916-491-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAII7641214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: