Healthcare Provider Details

I. General information

NPI: 1972086593
Provider Name (Legal Business Name): CONNECT THE DOTS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ST UNIT C101
CHULA VISTA CA
91910-2951
US

IV. Provider business mailing address

160 E ST UNIT C101
CHULA VISTA CA
91910-2951
US

V. Phone/Fax

Practice location:
  • Phone: 856-979-6733
  • Fax:
Mailing address:
  • Phone: 856-979-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RACHEL GABRIELLE FULLER
Title or Position: OWNER
Credential: LPCC
Phone: 856-979-6733