Healthcare Provider Details

I. General information

NPI: 1669910444
Provider Name (Legal Business Name): JODY PRATT-HARRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY KNIGHT

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SPORTFISHER DR
OCEANSIDE CA
92054-2550
US

IV. Provider business mailing address

1100 SPORTFISHER DR
OCEANSIDE CA
92054-2550
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-6702
  • Fax: 760-439-4779
Mailing address:
  • Phone: 760-439-6702
  • Fax: 760-439-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: