Provider Demographics
NPI:1376070011
Name:BEAVERS-SANCHEZ, TENCIA
Entity Type:Individual
Prefix:
First Name:TENCIA
Middle Name:
Last Name:BEAVERS-SANCHEZ
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 1:710 C ST STE 8
Mailing Address - Street 2:710 C STREET ,SUITE #8
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3853
Mailing Address - Country:US
Mailing Address - Phone:415-524-8521
Mailing Address - Fax:415-785-4023
Practice Address - Street 1:710 C STREET SUITE#8
Practice Address - Street 2:MARIN OUTPATIENT&RECOVERYSERVICES
Practice Address - City:SANRAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-524-8521
Practice Address - Fax:415-785-4023
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#20113AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)