Individual
AMANDA SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SUDRC 13199
Contact information
Practice address
310 HARRIS AVE STE A, SACRAMENTO, CA 95838-3249
(916) 649-6793
Mailing address
22 MARILYN CIR, SACRAMENTO, CA 95838-2017
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13199
CA
Other
Enumeration date
04/15/2022
Last updated
06/23/2022
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