Provider Demographics
NPI:1225272271
Name:SABOL, AUDREY G (LCSW)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:G
Last Name:SABOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 COLLEGE AVE STE 210B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1677
Mailing Address - Country:US
Mailing Address - Phone:510-869-5329
Mailing Address - Fax:
Practice Address - Street 1:5625 COLLEGE AVE STE 210B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1677
Practice Address - Country:US
Practice Address - Phone:510-869-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS182001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical