Provider Demographics
NPI:1518760545
Name:VAN DE WATER, SABINE
Entity type:Individual
Prefix:
First Name:SABINE
Middle Name:
Last Name:VAN DE WATER
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 1:148 OXBUROUGH DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3500
Mailing Address - Country:US
Mailing Address - Phone:925-405-7653
Mailing Address - Fax:
Practice Address - Street 1:929 SUTTER ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2453
Practice Address - Country:US
Practice Address - Phone:925-723-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124954101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health