Provider Demographics
NPI:1720381809
Name:PRICE, JANAE SHANAE
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:SHANAE
Last Name:PRICE
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 1:5063 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9697
Mailing Address - Country:US
Mailing Address - Phone:707-678-5614
Mailing Address - Fax:
Practice Address - Street 1:5063 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9697
Practice Address - Country:US
Practice Address - Phone:707-678-5614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health