Provider Demographics
NPI:1104001023
Name:ROSS, ANYA MARY
Entity Type:Individual
Prefix:MISS
First Name:ANYA
Middle Name:MARY
Last Name:ROSS
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 1:2440 SEAMIST DR
Mailing Address - Street 2:APT. 14
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-2346
Mailing Address - Country:US
Mailing Address - Phone:916-284-7916
Mailing Address - Fax:
Practice Address - Street 1:444 N 3RD ST
Practice Address - Street 2:SUITE 230
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-0226
Practice Address - Country:US
Practice Address - Phone:916-264-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)