Basic Information
| Provider Information | |||||||||
| NPI: | 1316333271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | SALLY | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6515 ALMOND AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGEVALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956623935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104333350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1133 COLOMA WAY | ||||||||
| Address2: | STE C | ||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956614480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182060360 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2015 | ||||||||
| LastUpdateDate: | 04/07/2015 | ||||||||
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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 | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.