Healthcare Provider Details

I. General information

NPI: 1336505858
Provider Name (Legal Business Name): WENDY DAWN PARKER CADC-CAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN BURGIN

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3594 4TH AVE
SAN DIEGO CA
92103-4989
US

IV. Provider business mailing address

1260 MORENA BLVD STE 100
SAN DIEGO CA
92110-3850
US

V. Phone/Fax

Practice location:
  • Phone: 619-296-1151
  • Fax: 619-296-6218
Mailing address:
  • Phone: 619-398-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC033920715
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: