Provider Demographics
NPI:1689859506
Name:SOCIAL ADVOCATES FOR YOUTH - SANTA MARIA, INC.
Entity type:Organization
Organization Name:SOCIAL ADVOCATES FOR YOUTH - SANTA MARIA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIMORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-928-1707
Mailing Address - Street 1:105 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4319
Mailing Address - Country:US
Mailing Address - Phone:805-928-1707
Mailing Address - Fax:805-922-4797
Practice Address - Street 1:251 E CLARK AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-4880
Practice Address - Country:US
Practice Address - Phone:805-937-6356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCIAL ADVOCATES FOR YOUTH - SANTA MARIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty