MEDICARE: INNER COMPASS, LICENSED CLINICAL SOCIAL WORKER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1578315735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER COMPASS, LICENSED CLINICAL SOCIAL WORKER, INC.

Provider Business Mailing Address
First Line	:	1410 W THORN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5337
Country	:	US
Telephone Number	:	714-253-7842
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 CAMINO DEL RIO S STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3728
Country	:	US
Telephone Number	:	714-253-7842
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER AND CLINICAL DIRECTOR
Name	:	MRS. NORA DAVIS
Credential	:	LCSW
Telephone Number	:	714-253-7842

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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