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General NPI Number Information
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NPI Number | 1134578156
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Entity Type | Individual
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Provider Name | LUSIJAH SUTHERLAND DARROW LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 2715 PORTER ST STE 204
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City | SOQUEL
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State | CA
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Zip | 95073-2437
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Country | US
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Telephone | 650-380-4821
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Fax | 831-603-3799
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Provider Business Mailing Address
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Address Line | 321 CAMINO AL MAR
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City | LA SELVA BEACH
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State | CA
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Zip | 95076-1513
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Country | US
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Telephone | 650-380-4821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT92106
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License Number State | CA
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