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General NPI Number Information
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NPI Number | 1033739321
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Entity Type | Organization
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Legal Business Name | YANCEY OUTREACH INTERNATIONAL INC.
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 2740 FULTON AVE STE 121
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City | SACRAMENTO
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State | CA
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Zip | 95821-5190
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Country | US
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Telephone | 916-252-3783
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 DEL PASO RD # 130-250
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City | SACRAMENTO
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State | CA
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Zip | 95835-2305
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Country | US
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Telephone | 916-914-5012
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | MR. MARK YANCEY SR.
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Credential |
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Telephone | 916-914-5012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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