Healthcare Provider Details

I. General information

NPI: 1548199680
Provider Name (Legal Business Name): DIGITAL DETOX FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3594 PAR FOUR DR
EL CAJON CA
92019-4637
US

IV. Provider business mailing address

2108 N ST # 4277
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 619-278-8728
  • Fax:
Mailing address:
  • Phone: 619-701-6716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: PETER LOPEZ-PEREZ
Title or Position: OWNER
Credential: LMFT
Phone: 619-278-8728