Healthcare Provider Details

I. General information

NPI: 1659794725
Provider Name (Legal Business Name): SAN DIEGO WELLNESS AND RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 357
LA MESA CA
91942-3027
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DR STE 357
LA MESA CA
91942-3027
US

V. Phone/Fax

Practice location:
  • Phone: 619-851-2479
  • Fax:
Mailing address:
  • Phone: 619-851-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number26112
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number26112
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number26112
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number26112
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number26112
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number26112
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number26112
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26112
License Number StateCA

VIII. Authorized Official

Name: KRISTIN STEELE
Title or Position: OWNER, CLINICAL PSYCHOLOGIST
Credential: PSY.D
Phone: 619-851-2479