Provider Demographics
NPI:1124203047
Name:SOCIAL ADVOCATES FOR YOUTH - SANTA MARIA, INC.
Entity Type:Organization
Organization Name:SOCIAL ADVOCATES FOR YOUTH - SANTA MARIA, INC.
Other - Org Name:SANTA MARIA VALLEY YOUTH & FAMILY CENTER
Other - Org Type:Doing Business As
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:LMFT
Authorized Official - Phone:805-928-1707
Mailing Address - Street 1:4460 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GUADALUPE
Mailing Address - State:CA
Mailing Address - Zip Code:93434-1420
Mailing Address - Country:US
Mailing Address - Phone:805-343-2446
Mailing Address - Fax:
Practice Address - Street 1:4460 10TH ST
Practice Address - Street 2:
Practice Address - City:GUADALUPE
Practice Address - State:CA
Practice Address - Zip Code:93434-1420
Practice Address - Country:US
Practice Address - Phone:805-343-2446
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
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty