Provider Demographics
NPI:1598419897
Name:PHOENIX-WILCOX, DEL RAE (MSW, ACSW)
Entity Type:Individual
Prefix:
First Name:DEL
Middle Name:RAE
Last Name:PHOENIX-WILCOX
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:CHICAGO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95712-0486
Mailing Address - Country:US
Mailing Address - Phone:530-559-6478
Mailing Address - Fax:
Practice Address - Street 1:3101 I ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4421
Practice Address - Country:US
Practice Address - Phone:530-648-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA869791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical