Provider Demographics
NPI:1104255298
Name:DUTTON, SALLY LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:LYNN
Last Name:DUTTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-0927
Mailing Address - Country:US
Mailing Address - Phone:805-994-9914
Mailing Address - Fax:
Practice Address - Street 1:940 RAMONA AVE STE J
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2155
Practice Address - Country:US
Practice Address - Phone:805-994-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW765651041C0700X, 1041C0700X
CAASW597811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical