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General NPI Number Information
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NPI Number | 1376070011
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Entity Type | Individual
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Provider Name | TENCIA BEAVERS-SANCHEZ
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Gender | Female
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 710 C STREET SUITE#8 MARIN OUTPATIENT&RECOVERYSERVICES
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City | SANRAFAEL
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State | CA
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Zip | 94901
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Country | US
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Telephone | 415-524-8521
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Fax | 415-785-4023
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Provider Business Mailing Address
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Address Line | 710 C ST STE 8 710 C STREET ,SUITE #8
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3853
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Country | US
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Telephone | 415-524-8521
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Fax | 415-785-4023
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | #20113AN
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License Number State | CA
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