Provider Demographics
NPI:1487011623
Name:GUTIERREZ, SANDRA (CADC-CAS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:CADC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11027 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2431
Mailing Address - Country:US
Mailing Address - Phone:818-985-8323
Mailing Address - Fax:818-768-9877
Practice Address - Street 1:8330 LANKERSHIM BLVD,
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605
Practice Address - Country:US
Practice Address - Phone:818-985-8323
Practice Address - Fax:818-768-9877
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC8021214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)