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General NPI Number Information
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NPI Number | 1235334236
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Entity Type | Organization
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Legal Business Name | S.A.G.E PROJECT
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 1800 GRAVENSTEIN HWY N
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City | SEBASTOPOL
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State | CA
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Zip | 95472-2607
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Country | US
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Telephone | 513-535-7702
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 GRAVENSTEIN HWY N
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City | SEBASTOPOL
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State | CA
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Zip | 95472-2607
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Country | US
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Telephone | 513-535-7702
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | NANCY HEILNER
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Credential | LCSW
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Telephone | 415-321-3159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1041C0700X
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License Number State | CA
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