Provider Demographics
NPI:1093550865
Name:WITMER, SALLY KENTON (LCSW)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:KENTON
Last Name:WITMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ELIZABETH KENTON
Other - Last Name:WITMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8697 LA MESA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9565
Mailing Address - Country:US
Mailing Address - Phone:408-221-1378
Mailing Address - Fax:
Practice Address - Street 1:VMR THERAPY
Practice Address - Street 2:5012 CENTRAL AVE, SUITE F
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902
Practice Address - Country:US
Practice Address - Phone:619-636-0909
Practice Address - Fax:619-500-5834
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1246601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical