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General NPI Number Information
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NPI Number | 1518177443
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Entity Type | Individual
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Provider Name | TINA LILLIEDOLL
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 500 JEFFERSON BLVD STE B180
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City | WEST SACRAMENTO
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State | CA
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Zip | 95605-2394
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Country | US
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Telephone | 916-403-2900
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Fax | 530-204-5248
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Provider Business Mailing Address
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Address Line | PO BOX 1260
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City | DAVIS
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State | CA
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Zip | 95617-1260
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Country | US
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Telephone | 530-753-3498
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 97349
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License Number State | CA
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