Healthcare Provider Details

I. General information

NPI: 1982889663
Provider Name (Legal Business Name): SALLY J BRAITHWAITE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N SAN ANTONIO RD
SANTA BARBARA CA
93110-1316
US

IV. Provider business mailing address

241 OCEAN VIEW AVE APT O
PISMO BEACH CA
93449-2658
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-5220
  • Fax: 805-865-1954
Mailing address:
  • Phone: 805-865-1943
  • Fax: 805-865-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 00009296
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: