Individual
MARY CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5340 SKYLANE BLVD, SANTA ROSA, CA 95403-8246
(707) 524-2711
Mailing address
2209 MIDWAY DR, SANTA ROSA, CA 95405-4956
(858) 736-5362
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
LEP4613
CA
106H00000X
Marriage & Family Therapist
LMFT96596
CA
Other
Enumeration date
06/18/2025
Last updated
06/18/2025
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