Basic Information
| Provider Information | |||||||||
| NPI: | 1811102114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORDYCE | ||||||||
| FirstName: | ADENE | ||||||||
| MiddleName: | HERING | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ACSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3815 MARCONI AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958213867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164854175 | ||||||||
| FaxNumber: | 9164852673 | ||||||||
| Practice Location | |||||||||
| Address1: | 3815 MARCONI AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958213867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164854175 | ||||||||
| FaxNumber: | 9164852673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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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 | 104100000X | ASW 23948 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.