Healthcare Provider Details

I. General information

NPI: 1487301099
Provider Name (Legal Business Name): ABBY ALEXANDRA AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BROADWAY
SACRAMENTO CA
95820-1527
US

IV. Provider business mailing address

4600 BROADWAY
SACRAMENTO CA
95820-1527
US

V. Phone/Fax

Practice location:
  • Phone: 279-782-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number158537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: