Healthcare Provider Details

I. General information

NPI: 1164265435
Provider Name (Legal Business Name): DRIFTWOOD FAMILY THERAPY COLLECTIVE, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 ENCINITAS BLVD STE 248
ENCINITAS CA
92024-6792
US

IV. Provider business mailing address

1038 EVERGREEN DR
ENCINITAS CA
92024-3915
US

V. Phone/Fax

Practice location:
  • Phone: 310-874-2872
  • Fax: 760-650-0990
Mailing address:
  • Phone: 310-874-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: HANNAH NYZNYK
Title or Position: OWNER
Credential: LMFT
Phone: 310-874-2872