Healthcare Provider Details

I. General information

NPI: 1811323066
Provider Name (Legal Business Name): BIANCA TAYNE PAYNE N/A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 TENNESSE ST
VALLEJO CA
94591
US

IV. Provider business mailing address

2218 SILVERFOX CIRCLE
FAIRFIELD CA
94534
US

V. Phone/Fax

Practice location:
  • Phone: 707-554-2397
  • Fax:
Mailing address:
  • Phone: 510-938-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: