Provider Demographics
NPI:1114782679
Name:SITHOUNNOLAT, SENGTHONG
Entity Type:Individual
Prefix:
First Name:SENGTHONG
Middle Name:
Last Name:SITHOUNNOLAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 3RD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-1409
Mailing Address - Country:US
Mailing Address - Phone:628-217-7000
Mailing Address - Fax:628-217-7002
Practice Address - Street 1:901 FAIRFAX AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3040
Practice Address - Country:US
Practice Address - Phone:628-217-5220
Practice Address - Fax:415-641-3815
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty