Basic Information
| Provider Information | |||||||||
| NPI: | 1427575984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | JADE | ||||||||
| MiddleName: | JOINEA | ||||||||
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| Credential: | |||||||||
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| OtherLastName: | PERRY | ||||||||
| OtherFirstName: | JADE | ||||||||
| OtherMiddleName: | JOINEA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3780 ROSIN CT STE 110 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164410226 | ||||||||
| FaxNumber: | 9164410286 | ||||||||
| Practice Location | |||||||||
| Address1: | 4433 FLORIN RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958232527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162342577 | ||||||||
| FaxNumber: | 9162362577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2017 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 172V00000X | N | Other Service Providers | Community Health Worker | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.