Healthcare Provider Details

I. General information

NPI: 1366295602
Provider Name (Legal Business Name): A SEED OF CHANGE MARRIAGE AND FAMILY THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 PALOMAR AIRPORT RD STE 202
CARLSBAD CA
92011-1433
US

IV. Provider business mailing address

2131 PALOMAR AIRPORT RD STE 202
CARLSBAD CA
92011-1433
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-8008
  • Fax: 760-305-7115
Mailing address:
  • Phone: 760-305-8008
  • Fax: 760-305-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSLYN J REECE
Title or Position: CEO/OWNER
Credential: PHD
Phone: 760-305-8008