Provider Demographics
NPI:1417672684
Name:CULLINS, SANDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:CULLINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 CAMINO DEL RIO S STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3560
Mailing Address - Country:US
Mailing Address - Phone:877-404-1967
Mailing Address - Fax:619-810-0383
Practice Address - Street 1:409 CAMINO DEL RIO S STE 310
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3560
Practice Address - Country:US
Practice Address - Phone:877-404-1967
Practice Address - Fax:619-810-0383
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty