Healthcare Provider Details

I. General information

NPI: 1972029122
Provider Name (Legal Business Name): ANIA CHANELLE TOWNSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 02/11/2022
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 CORPORATE WAY
SACRAMENTO CA
95831-3888
US

IV. Provider business mailing address

1800 HARRISON ST, 7TH FL
OAKLAND CA
94612-3429
US

V. Phone/Fax

Practice location:
  • Phone: 916-424-3700
  • Fax:
Mailing address:
  • Phone: 510-625-2856
  • Fax: 877-737-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32613
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: