| NPI | 1962118539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN MEDALIE CEO 619-997-5759 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2023-01-26 |