Healthcare Provider Details

I. General information

NPI: 1437450384
Provider Name (Legal Business Name): PRISCILLA APODACA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 FARNHAM ST SUITE 100
SAN DIEGO CA
92123-1308
US

IV. Provider business mailing address

9445 FARNHAM ST SUITE 100
SAN DIEGO CA
92123-1308
US

V. Phone/Fax

Practice location:
  • Phone: 619-209-0310
  • Fax: 858-569-2418
Mailing address:
  • Phone: 619-209-0310
  • Fax: 858-569-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77448
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: