Provider Demographics
NPI:1306366042
Name:MCALLISTER, DESIREE ANNA
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:ANNA
Last Name:MCALLISTER
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 1:565 ARCADE BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-1118
Mailing Address - Country:US
Mailing Address - Phone:916-897-1019
Mailing Address - Fax:
Practice Address - Street 1:3009 C ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3326
Practice Address - Country:US
Practice Address - Phone:916-442-2396
Practice Address - Fax:916-442-2525
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician