Provider Demographics
NPI:1710178926
Name:VAN WAARDENBURG, SUNNI M (MS)
Entity Type:Individual
Prefix:MS
First Name:SUNNI
Middle Name:M
Last Name:VAN WAARDENBURG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 LONG BEACH BLVD FL 5
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3315
Mailing Address - Country:US
Mailing Address - Phone:562-216-2180
Mailing Address - Fax:562-426-4661
Practice Address - Street 1:3711 LONG BEACH BLVD FL 5
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3315
Practice Address - Country:US
Practice Address - Phone:562-216-2180
Practice Address - Fax:562-426-4661
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7B38043101YM0800X
CA48891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health