Provider Demographics
NPI:1811537343
Name:WARNER, SYLVIA SUPREME
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:SUPREME
Last Name:WARNER
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 1:956 KATE LINDE CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-5238
Mailing Address - Country:US
Mailing Address - Phone:209-242-4150
Mailing Address - Fax:
Practice Address - Street 1:42 W 8TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4123
Practice Address - Country:US
Practice Address - Phone:209-229-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health