Provider Demographics
NPI:1902830235
Name:SAMARITAN COUNSELING CENTER OF GREATER SACRAMENTO
Entity Type:Organization
Organization Name:SAMARITAN COUNSELING CENTER OF GREATER SACRAMENTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-456-4614
Mailing Address - Street 1:3701 J ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5542
Mailing Address - Country:US
Mailing Address - Phone:916-456-4614
Mailing Address - Fax:916-456-4624
Practice Address - Street 1:3701 J ST STE 207
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5542
Practice Address - Country:US
Practice Address - Phone:916-456-4614
Practice Address - Fax:916-456-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW196141041C0700X
CAMFC37882106H00000X
CAMFC27154106H00000X
CAMFC11904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty