Provider Demographics
NPI:1194808584
Name:FAYE GEORGE
Entity type:Organization
Organization Name:FAYE GEORGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR LL
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-391-4192
Mailing Address - Street 1:4902 KOKOMO DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1806
Mailing Address - Country:US
Mailing Address - Phone:916-391-4192
Mailing Address - Fax:916-391-4247
Practice Address - Street 1:4902 KOKOMO DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1806
Practice Address - Country:US
Practice Address - Phone:916-391-4192
Practice Address - Fax:916-391-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4986101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty