Provider Demographics
NPI:1992244057
Name:CLIMMONS, VENORA
Entity type:Individual
Prefix:
First Name:VENORA
Middle Name:
Last Name:CLIMMONS
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 1:3321 POWER INN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3893
Mailing Address - Country:US
Mailing Address - Phone:916-441-0132
Mailing Address - Fax:916-441-6893
Practice Address - Street 1:3321 POWER INN RD STE 110
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3893
Practice Address - Country:US
Practice Address - Phone:916-441-0132
Practice Address - Fax:916-441-6893
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor