Healthcare Provider Details

I. General information

NPI: 1194808584
Provider Name (Legal Business Name): FAYE GEORGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 KOKOMO DR
SACRAMENTO CA
95835-1806
US

IV. Provider business mailing address

4902 KOKOMO DR
SACRAMENTO CA
95835-1806
US

V. Phone/Fax

Practice location:
  • Phone: 916-391-4192
  • Fax: 916-391-4247
Mailing address:
  • Phone: 916-391-4192
  • Fax: 916-391-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4986
License Number StateCA

VIII. Authorized Official

Name: MRS. FAYE ETTA GEORGE
Title or Position: COUNSELOR LL
Credential:
Phone: 916-391-4192