Healthcare Provider Details

I. General information

NPI: 1154083327
Provider Name (Legal Business Name): SHAWNDA DARICE CHRISTIANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FULTON AVE STE 205
SACRAMENTO CA
95825-4517
US

IV. Provider business mailing address

310 HARRIS AVE STE A
SACRAMENTO CA
95838-3249
US

V. Phone/Fax

Practice location:
  • Phone: 916-484-3570
  • Fax:
Mailing address:
  • Phone: 916-649-6793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC6351214
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC6351214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: