Provider Demographics
NPI:1003357302
Name:SERGEEFF, MONIQUE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:SERGEEFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 HURLEY WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3253
Mailing Address - Country:US
Mailing Address - Phone:916-922-9217
Mailing Address - Fax:916-921-1128
Practice Address - Street 1:2143 HURLEY WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3253
Practice Address - Country:US
Practice Address - Phone:916-922-9217
Practice Address - Fax:916-921-1128
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)