Provider Demographics
NPI:1215131206
Name:SIERRA COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE
Entity type:Organization
Organization Name:SIERRA COUNCIL ON ALCOHOLISM & DRUG DEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:916-797-8989
Mailing Address - Street 1:11960 HERITAGE OAK PL
Mailing Address - Street 2:SUITE 15
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2401
Mailing Address - Country:US
Mailing Address - Phone:530-885-1961
Mailing Address - Fax:530-885-0713
Practice Address - Street 1:11960 HERITAGE OAK PL
Practice Address - Street 2:SUITE 15
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2401
Practice Address - Country:US
Practice Address - Phone:530-885-1961
Practice Address - Fax:530-885-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310001EN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31 ABOtherMEDI-CAL