Provider Demographics
NPI:1629194360
Name:SOUZA, ALLYCIA DAWN (LMFT)
Entity Type:Individual
Prefix:
First Name:ALLYCIA
Middle Name:DAWN
Last Name:SOUZA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E ALAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3046
Mailing Address - Country:US
Mailing Address - Phone:510-374-8560
Mailing Address - Fax:
Practice Address - Street 1:133 E ALAMAR AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3046
Practice Address - Country:US
Practice Address - Phone:510-374-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48056106H00000X
CAMFTI 52783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health