Provider Demographics
NPI:1861632739
Name:SANTOS, DENA CHANTE
Entity Type:Individual
Prefix:MRS
First Name:DENA
Middle Name:CHANTE
Last Name:SANTOS
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 1:10087 TERRA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3202
Mailing Address - Country:US
Mailing Address - Phone:916-640-5510
Mailing Address - Fax:916-451-4018
Practice Address - Street 1:10087 TERRA LOMA DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-3202
Practice Address - Country:US
Practice Address - Phone:916-640-5510
Practice Address - Fax:916-451-4018
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8362101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)