MEDICARE: FAYE GEORGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	4986	CA

General Provider Information

NPI Number	:	1194808584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAYE GEORGE

Provider Business Mailing Address
First Line	:	4902 KOKOMO DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1806
Country	:	US
Telephone Number	:	916-391-4192
Fax Number	:	916-391-4247

Provider Business Practice Location Address
First Line	:	4902 KOKOMO DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1806
Country	:	US
Telephone Number	:	916-391-4192
Fax Number	:	916-391-4247

Authorized Official
Title or Position	:	COUNSELOR LL
Name	:	MRS. FAYE ETTA GEORGE
Credential	:
Telephone Number	:	916-391-4192

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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Directions to “FAYE GEORGE ” Practice Location

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