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General NPI Number Information
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NPI Number | 1588737084
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Entity Type | Organization
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Legal Business Name | COUNTY MENTAL HEALTH CLINIC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 W FOSTER RD
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City | SANTA MARIA
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State | CA
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Zip | 93455-3620
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Country | US
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Telephone | 805-934-2170
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Fax |
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Provider Business Mailing Address
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Address Line | 422 CLUBHOUSE DR
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City | SANTA MARIA
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State | CA
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Zip | 93455-3633
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Country | US
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Telephone | 805-934-2170
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH PROCTITIONER -INTERN
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Name | MRS. DALILA FIGUEROA SEPULVEDA
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Credential | MSW
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Telephone | 806-934-6367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW 12749
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License Number State | CA
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