Provider Demographics
NPI:1093914152
Name:WORTLEY, SANDY LEA (RAS)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:LEA
Last Name:WORTLEY
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 WHISPERING TRAILS PL
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-6396
Mailing Address - Country:US
Mailing Address - Phone:805-674-3131
Mailing Address - Fax:866-306-5825
Practice Address - Street 1:2000 TRAFFIC WAY
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-1523
Practice Address - Country:US
Practice Address - Phone:805-674-3131
Practice Address - Fax:866-306-5825
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW0411010859101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW0411010859OtherBREINING UNIVERSITY/REGIS