Provider Demographics
NPI:1023473097
Name:SARGENT, GRAHAM (CADC-II-ICADC-ICCJP)
Entity type:Individual
Prefix:MR
First Name:GRAHAM
Middle Name:
Last Name:SARGENT
Suffix:
Gender:M
Credentials:CADC-II-ICADC-ICCJP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 FLORIN PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3900
Mailing Address - Country:US
Mailing Address - Phone:916-875-1119
Mailing Address - Fax:
Practice Address - Street 1:3201 FLORIN PERKINS RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3900
Practice Address - Country:US
Practice Address - Phone:916-875-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI2580315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI2580315OtherCCAPP CADC-1