Individual
ALEKSEY DEREVYANCHUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC II
Contact information
Practice address
5150 SUNRISE BLVD STE F4, FAIR OAKS, CA 95628-4964
(888) 299-9987
Mailing address
5150 SUNRISE BLVD STE F4, FAIR OAKS, CA 95628-4964
(888) 299-9987
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A058671120
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A058671120
CA
101YM0800X
Mental Health Counselor
A058671120
CA
Other
Enumeration date
01/11/2021
Last updated
01/31/2022
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