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Individual
DR. SALLY WYNN
Active
Individual
DR. SALLY WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDCC IV-CS
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5940
CA
101YA0400X
Addiction (Substance Use Disorder) Counselor
W0702211501
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5940
CALIFORNIA ASSOCIATION OF DUI TREATMENT PROGRAMS
CA
01
—
W0702211501
BREINING - MASTERS LEVEL REGISTERED ADDICTION SPECIALIST
CA
Enumeration date
04/18/2012
Last updated
11/08/2021
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