Provider Demographics
NPI:1396420972
Name:NAM, MARGARET ANNE
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANNE
Last Name:NAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ANNE
Other - Last Name:WOODWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 1762
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1762
Mailing Address - Country:US
Mailing Address - Phone:805-703-4082
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1762
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93116-1762
Practice Address - Country:US
Practice Address - Phone:805-703-4082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC14629101YP2500X
HIMHC312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health