Provider Demographics
NPI:1285906560
Name:CASTANEDA, SABRINA LOUISE (CRC)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:LOUISE
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 MISSION GORGE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4106
Mailing Address - Country:US
Mailing Address - Phone:619-228-8025
Mailing Address - Fax:619-228-8030
Practice Address - Street 1:4525 MISSION GORGE PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4106
Practice Address - Country:US
Practice Address - Phone:619-228-8025
Practice Address - Fax:619-228-8030
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00111815101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health