Healthcare Provider Details

I. General information

NPI: 1730779604
Provider Name (Legal Business Name): SACRED BONDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 04/05/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14570 MONO WAY STE A
SONORA CA
95370-8997
US

IV. Provider business mailing address

17775 PLAZA DEL SUR RD
SONORA CA
95370-8726
US

V. Phone/Fax

Practice location:
  • Phone: 209-617-9456
  • Fax: 209-396-2974
Mailing address:
  • Phone: 209-617-9456
  • Fax: 209-396-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO ABARCA
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 209-617-9456