Provider Demographics
NPI:1477029148
Name:LYNCH, SALLY JEANNE (AMFT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JEANNE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3539 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-7032
Mailing Address - Country:US
Mailing Address - Phone:619-823-3475
Mailing Address - Fax:
Practice Address - Street 1:3539 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-7032
Practice Address - Country:US
Practice Address - Phone:619-823-3475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3704Medicaid