Provider Demographics
NPI:1952421588
Name:BENAVIDES, NORMA WILDER (MFT)
Entity type:Individual
Prefix:MS
First Name:NORMA
Middle Name:WILDER
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:NORMA
Other - Middle Name:ROYALE
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:303 W VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3628
Mailing Address - Country:US
Mailing Address - Phone:805-564-8606
Mailing Address - Fax:
Practice Address - Street 1:117 E CARRILLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2110
Practice Address - Country:US
Practice Address - Phone:805-882-3715
Practice Address - Fax:805-882-3764
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health