Basic Information
| Provider Information | |||||||||
| NPI: | 1164531398 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DHHS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHILD AND FAMILY ACCESS TEAM | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3331 POWER INN RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958263889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168767770 | ||||||||
| FaxNumber: | 9168759970 | ||||||||
| Practice Location | |||||||||
| Address1: | 3331 POWER INN RD | ||||||||
| Address2: | STE 170 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958263889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168767770 | ||||||||
| FaxNumber: | 9168759970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | XIONG | ||||||||
| AuthorizedOfficialFirstName: | YENG | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR MENTAL HEALTH COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 9168767770 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW 13382 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.