Healthcare Provider Details

I. General information

NPI: 1417856469
Provider Name (Legal Business Name): TENISHA LAFAYE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TENISHA HARRIS

II. Dates (important events)

Enumeration Date: 11/04/2026
Last Update Date: 11/04/2026
Certification Date: 11/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 E MAIN ST # 238
EL CAJON CA
92021-5902
US

IV. Provider business mailing address

1527 E MAIN ST # 238
EL CAJON CA
92021-5902
US

V. Phone/Fax

Practice location:
  • Phone: 619-438-5346
  • Fax:
Mailing address:
  • Phone: 619-438-5346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1463321026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: