Provider Demographics
NPI:1235445420
Name:CEBULLA, IOANA BLANCA (PHD CLINICAL PSYCH)
Entity Type:Individual
Prefix:DR
First Name:IOANA
Middle Name:BLANCA
Last Name:CEBULLA
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCH
Other - Prefix:MS
Other - First Name:IOANA
Other - Middle Name:BLANCA
Other - Last Name:BARSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-8922
Mailing Address - Country:US
Mailing Address - Phone:805-543-1636
Mailing Address - Fax:
Practice Address - Street 1:1550 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4819
Practice Address - Country:US
Practice Address - Phone:805-354-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CA67202101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist