Basic Information
| Provider Information | |||||||||
| NPI: | 1770918187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TINNEY | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | CHRIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3780 ROSIN CT STE 110 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164410226 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3870 ROSIN CT STE 130 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164410226 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2013 | ||||||||
| LastUpdateDate: | 09/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.