Provider Demographics
NPI:1861951139
Name:SUNDERLAND-FITZSIMMONS, JENNIFER ANNE (CADC I)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNE
Last Name:SUNDERLAND-FITZSIMMONS
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SUNDERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15707 M ST
Mailing Address - Street 2:
Mailing Address - City:MOJAVE
Mailing Address - State:CA
Mailing Address - Zip Code:93501-1720
Mailing Address - Country:US
Mailing Address - Phone:775-790-4120
Mailing Address - Fax:
Practice Address - Street 1:15707 M ST
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1720
Practice Address - Country:US
Practice Address - Phone:775-790-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)