Provider Demographics
NPI:1902053416
Name:SANNER, AMBER JOY (MS, PPSC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:JOY
Last Name:SANNER
Suffix:
Gender:F
Credentials:MS, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 VALLE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-3360
Mailing Address - Country:US
Mailing Address - Phone:510-907-1656
Mailing Address - Fax:
Practice Address - Street 1:3219 PIERCE ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-5910
Practice Address - Country:US
Practice Address - Phone:510-231-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist