Provider Demographics
NPI:1396864039
Name:GATHER, SANDRA ANNE (MS, CADC)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ANNE
Last Name:GATHER
Suffix:
Gender:F
Credentials:MS, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 DIAMOND GROVE CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4606
Mailing Address - Country:US
Mailing Address - Phone:916-543-9534
Mailing Address - Fax:
Practice Address - Street 1:ASOC - 11533 C AVENUE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:916-784-6087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3598293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)