Provider Demographics
NPI:1063748077
Name:RICKARD, AMANDA LORENA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LORENA
Last Name:RICKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 HUCKLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-9208
Mailing Address - Country:US
Mailing Address - Phone:209-772-2801
Mailing Address - Fax:
Practice Address - Street 1:3353 BRADSHAW RD STE 106
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2608
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)