Healthcare Provider Details

I. General information

NPI: 1093440372
Provider Name (Legal Business Name): MARCELLA ANN BRESNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCELLA ANN RELPH

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 CLAIREMONT MESA BLVD
SAN DIEGO CA
92123-1104
US

IV. Provider business mailing address

8910 CLAIREMONT MESA BLVD
SAN DIEGO CA
92123-1104
US

V. Phone/Fax

Practice location:
  • Phone: 858-514-5144
  • Fax: 858-514-5195
Mailing address:
  • Phone: 858-514-5144
  • Fax: 858-514-5195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC10180
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: