| NPI | 1760179030 |
|---|---|
| Former Legal Business Name | SANDRA KNICKERBOCKER, LMFT |
| Entity Type | Organization |
| Authorized Contact | SANDRA LEE KNICKERBOCKER Lmft/President 619-937-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-04-18 |