Healthcare Provider Details

I. General information

NPI: 1376996363
Provider Name (Legal Business Name): HEALING HEARTS COUNSELING CENTER SAN DIEGO INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N EL CAMINO REAL STE 306
ENCINITAS CA
92024-2814
US

IV. Provider business mailing address

317 N EL CAMINO REAL STE 306
ENCINITAS CA
92024-2814
US

V. Phone/Fax

Practice location:
  • Phone: 760-458-1600
  • Fax: 858-673-4499
Mailing address:
  • Phone: 760-458-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2992
License Number StateCA

VIII. Authorized Official

Name: JENNIFER DELORIS LITTLE
Title or Position: PRESIDENT/ COUNSELOR
Credential:
Phone: 760-458-1600