Provider Demographics
NPI:1316284086
Name:HOWARD, SALLY DEGOLLADO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:DEGOLLADO
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2401
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78768-2401
Mailing Address - Country:US
Mailing Address - Phone:512-992-1411
Mailing Address - Fax:
Practice Address - Street 1:5120 BANTOM WOODS BND
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-6235
Practice Address - Country:US
Practice Address - Phone:512-992-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79103171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator