Healthcare Provider Details

I. General information

NPI: 1376207613
Provider Name (Legal Business Name): DEVITA EUGENIA ANDREWS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8058 LA MESA BLVD
LA MESA CA
91942-0335
US

IV. Provider business mailing address

PO BOX 532761
SAN DIEGO CA
92153-2761
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-9742
  • Fax: 619-463-2522
Mailing address:
  • Phone: 619-348-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14926-RAC
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: