Healthcare Provider Details

I. General information

NPI: 1134469299
Provider Name (Legal Business Name): LUCINDA EVANS FAISON-OLSEN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 CAMINO DEL MAR APT 2
DEL MAR CA
92014-3000
US

IV. Provider business mailing address

460 CAMINO DEL MAR APT 2
DEL MAR CA
92014-3000
US

V. Phone/Fax

Practice location:
  • Phone: 808-854-1884
  • Fax: 808-328-9234
Mailing address:
  • Phone: 808-854-1884
  • Fax: 808-328-9234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number324
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number43383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: