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General NPI Number Information
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NPI Number | 1275823288
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Entity Type | Individual
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Provider Name | BRENDA DARLENE BALLANTINE M.A.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 4343 WILLIAMSBURG DR.
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City | SACRAMENTO
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State | CA
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Zip | 95823
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Country | US
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Telephone | 916-473-5766
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Fax |
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Provider Business Mailing Address
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Address Line | 628 REEDS AVE
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City | RED BLUFF
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State | CA
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Zip | 96080-4273
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Country | US
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Telephone | 530-200-1452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | CA
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