Provider Demographics
NPI:1619054038
Name:SCULLY, DONALD JAMES (MFT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JAMES
Last Name:SCULLY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 ADAMS ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1148
Mailing Address - Country:US
Mailing Address - Phone:707-525-1937
Mailing Address - Fax:707-963-1947
Practice Address - Street 1:999 ADAMS ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1148
Practice Address - Country:US
Practice Address - Phone:707-525-1937
Practice Address - Fax:707-963-1947
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist