Healthcare Provider Details

I. General information

NPI: 1336078716
Provider Name (Legal Business Name): SALLY JEANETTE BOONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WEEOT WAY
ARCATA CA
95521-4734
US

IV. Provider business mailing address

PO BOX 31
SAMOA CA
95564-0031
US

V. Phone/Fax

Practice location:
  • Phone: 707-825-5000
  • Fax:
Mailing address:
  • Phone: 707-362-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: