Healthcare Provider Details

I. General information

NPI: 1942649140
Provider Name (Legal Business Name): LAURIE SUSAN SANFORD CADC-III B0000290719
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 SUBURBIA AVE
SANTA CRUZ CA
95062-1250
US

IV. Provider business mailing address

174 SUBURBIA AVE
SANTA CRUZ CA
95062-1250
US

V. Phone/Fax

Practice location:
  • Phone: 831-295-8410
  • Fax:
Mailing address:
  • Phone: 831-713-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberB0000290719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: