Healthcare Provider Details

I. General information

NPI: 1326664731
Provider Name (Legal Business Name): ANDRESSA GOMES GIACOMINI AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT STE A
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

6219 STANLEY AVE APT 7
SAN DIEGO CA
92115-4048
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-7528
  • Fax: 760-509-4410
Mailing address:
  • Phone: 781-426-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAMFT117080
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAMFT117080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: