Provider Demographics
NPI:1952612830
Name:RAIFORD, TERRI D
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:D
Last Name:RAIFORD
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 1:1149 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7512
Mailing Address - Country:US
Mailing Address - Phone:707-552-5295
Mailing Address - Fax:707-552-3394
Practice Address - Street 1:4343 WILLIAMSBOURGH DRIVE1901
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-395-3552
Practice Address - Fax:916-395-3683
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA101YA0400X
CAAII63340522101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)