Healthcare Provider Details

I. General information

NPI: 1356264907
Provider Name (Legal Business Name): MS. VICTORIA MICHELLE GARTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 HURLEY WAY # 145B
SACRAMENTO CA
95825-3223
US

IV. Provider business mailing address

6900 2ND ST
RIO LINDA CA
95673-2144
US

V. Phone/Fax

Practice location:
  • Phone: 707-205-5254
  • Fax:
Mailing address:
  • Phone: 707-205-5254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1570830724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: