Healthcare Provider Details

I. General information

NPI: 1104223742
Provider Name (Legal Business Name): STRATEGIES FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 LEMON HILL AVE
SACRAMENTO CA
95824-3225
US

IV. Provider business mailing address

4441 AUBURN BLVD STE E
SACRAMENTO CA
95841-4139
US

V. Phone/Fax

Practice location:
  • Phone: 916-473-5764
  • Fax:
Mailing address:
  • Phone: 916-473-5764
  • Fax: 916-473-5766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number340084BN
License Number StateCA

VIII. Authorized Official

Name: BJ DAVIS
Title or Position: EXECUTIVE DIRECTOR
Credential: PSYD
Phone: 916-395-3552