Provider Demographics
NPI:1386781425
Name:TERRA NOVA COUNSELING
Entity type:Organization
Organization Name:TERRA NOVA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-344-0249
Mailing Address - Street 1:7844 MADISON AVENUE, SUITE #152
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628
Mailing Address - Country:US
Mailing Address - Phone:916-344-0249
Mailing Address - Fax:
Practice Address - Street 1:4700 NORTHGATE BLVD
Practice Address - Street 2:SUITE 122
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1128
Practice Address - Country:US
Practice Address - Phone:916-564-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMEDICAL PROVIDER #