Healthcare Provider Details

I. General information

NPI: 1407580418
Provider Name (Legal Business Name): HEALING HOPES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13512 DEL MARINO AVE
POWAY CA
92064
US

IV. Provider business mailing address

4275 EXECUTIVE SQ STE 200
LA JOLLA CA
92037-1476
US

V. Phone/Fax

Practice location:
  • Phone: 619-897-4325
  • Fax: 858-668-0808
Mailing address:
  • Phone: 619-897-4325
  • Fax: 858-668-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: OTISHIA HILL
Title or Position: LCSW
Credential: LCSW
Phone: 619-897-4325