| NPI | 1710741558 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAINA R PONCE Owner/CEO 619-786-5866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 251S00000X | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-09-06 |