Individual
CLARISSA SHADAE CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2829 WATT AVE, SACRAMENTO, CA 95821-6200
(916) 531-0143
Mailing address
811 GRAND AVE, SACRAMENTO, CA 95838-3466
(916) 922-9868
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
05/10/2019
Last updated
04/25/2025
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