Provider Demographics
NPI:1508936089
Name:SEALUND, ALICE I
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:I
Last Name:SEALUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-4826
Mailing Address - Country:US
Mailing Address - Phone:805-736-5149
Mailing Address - Fax:
Practice Address - Street 1:401 E CYPRESS AVE FL 2
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6806
Practice Address - Country:US
Practice Address - Phone:805-737-7715
Practice Address - Fax:805-737-7726
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health