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General NPI Number Information
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NPI Number | 1134588023
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Entity Type | Organization
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Legal Business Name | SONOMA FAMILY THERAPY INC
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Dates
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Enumeration Date | 02/19/2016
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 2230 PROFESSIONAL DR STE A
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City | SANTA ROSA
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State | CA
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Zip | 95403-3015
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Country | US
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Telephone | 707-483-9061
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Fax |
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Provider Business Mailing Address
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Address Line | 2635 CLEVELAND AVE STE 10
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City | SANTA ROSA
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State | CA
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Zip | 95403-2997
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Country | US
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Telephone | 707-889-7317
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER BALLARD
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Credential |
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Telephone | 707-889-7317
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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 |
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License Number State |
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