Basic Information
| Provider Information | |||||||||
| NPI: | 1851781967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAINES | ||||||||
| FirstName: | AMBERLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2757 ROYAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | CAMERON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956829215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178005333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9343 TECH CENTER DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958262592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163886400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2015 | ||||||||
| LastUpdateDate: | 02/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW64634 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.