Healthcare Provider Details

I. General information

NPI: 1477801314
Provider Name (Legal Business Name): SHIBA RAHIMI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 RIVER PARK DR STE 103
SACRAMENTO CA
95815-4603
US

IV. Provider business mailing address

1555 RIVER PARK DR STE 103
SACRAMENTO CA
95815-4603
US

V. Phone/Fax

Practice location:
  • Phone: 916-692-8837
  • Fax: 916-200-3196
Mailing address:
  • Phone: 916-692-8837
  • Fax: 916-200-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number2012813
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: