Doctor Name: | MS. NICOLE KATHRYN SARDELLA |
NPI Number: | 1093045635 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 24321 County Road 96 Davis, CA - 956163153 |
Business Phone Number: | 5307531653 |
Business Fax Number: | |
Mailing Address: | Po Box 431, DAVIS |
State: | CA |
Postal Code: | 956163153 |
Phone Number: | 5307531653 |
Fax Number: | |
NPI Enumeration Date: | 01/04/2010 |
NPI Last Update Date: | 10/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |