Healthcare Provider Details

I. General information

NPI: 1124868484
Provider Name (Legal Business Name): ANNECY DAGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 OBERLIN DR STE 112
SAN DIEGO CA
92121-3743
US

IV. Provider business mailing address

3852 JEWELL ST APT L103
SAN DIEGO CA
92109-6418
US

V. Phone/Fax

Practice location:
  • Phone: 619-549-0329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC16523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: