Provider Demographics
NPI:1811102114
Name:FORDYCE, ADENE HERING (ACSW)
Entity type:Individual
Prefix:MRS
First Name:ADENE
Middle Name:HERING
Last Name:FORDYCE
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 MARCONI AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3867
Mailing Address - Country:US
Mailing Address - Phone:916-485-4175
Mailing Address - Fax:916-485-2673
Practice Address - Street 1:3815 MARCONI AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3867
Practice Address - Country:US
Practice Address - Phone:916-485-4175
Practice Address - Fax:916-485-2673
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 23948104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker