Provider Demographics
NPI:1407912173
Name:SIMS PILJAY, JACKIE (CCS)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:
Last Name:SIMS PILJAY
Suffix:
Gender:F
Credentials:CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 TOKAY CMN
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4855
Mailing Address - Country:US
Mailing Address - Phone:925-337-3675
Mailing Address - Fax:
Practice Address - Street 1:815 BUENA VISTA AVE W
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-4108
Practice Address - Country:US
Practice Address - Phone:415-934-6872
Practice Address - Fax:415-863-0622
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380019BN324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility