Healthcare Provider Details

I. General information

NPI: 1578195301
Provider Name (Legal Business Name): MRS. FANICA BRINTEE SIMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7225 E SOUTHGATE DR STE D
SACRAMENTO CA
95823-2651
US

IV. Provider business mailing address

600 BERCUT DR
SACRAMENTO CA
95811-0131
US

V. Phone/Fax

Practice location:
  • Phone: 916-394-1000
  • Fax: 916-394-1010
Mailing address:
  • Phone: 916-440-1500
  • Fax: 916-440-1514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19895
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: