Healthcare Provider Details

I. General information

NPI: 1063637015
Provider Name (Legal Business Name): COUNSELING & BEHAVIORAL SPECIALISTS, AFCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9029 PARK PLAZA DR SUITE #101
LA MESA CA
91942-3436
US

IV. Provider business mailing address

9029 PARK PLAZA DR SUITE #101
LA MESA CA
91942-3436
US

V. Phone/Fax

Practice location:
  • Phone: 619-697-0470
  • Fax: 619-697-0505
Mailing address:
  • Phone: 619-697-0470
  • Fax: 619-697-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JORDANNA FERN WASILESKU
Title or Position: OWNER
Credential: MFT, RPT-S
Phone: 619-697-0470