Healthcare Provider Details

I. General information

NPI: 1841706264
Provider Name (Legal Business Name): RITUALS OF HEALING PSYCHOLOGY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 2ND ST STE A
ENCINITAS CA
92024-3568
US

IV. Provider business mailing address

13561 LAVENDER WAY
SAN DIEGO CA
92130-5651
US

V. Phone/Fax

Practice location:
  • Phone: 858-353-8530
  • Fax: 858-880-0146
Mailing address:
  • Phone: 858-353-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY25050
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. REGINA LYNN HUELSENBECK
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 858-353-8530