Healthcare Provider Details

I. General information

NPI: 1174032387
Provider Name (Legal Business Name): WHITNEY IMANI LIGONDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8898 CLAIREMONT MESA BLVD STE H
SAN DIEGO CA
92123-1127
US

IV. Provider business mailing address

8898 CLAIREMONT MESA BLVD SUITE H
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-715-1211
  • Fax:
Mailing address:
  • Phone: 617-971-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: