Healthcare Provider Details

I. General information

NPI: 1821916289
Provider Name (Legal Business Name): AMETHYST HOLISTIC COUNSELING, A PROFESSIONAL CLINICAL COUNSELOR CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5952 TROJAN AVE
SAN DIEGO CA
92115-5406
US

IV. Provider business mailing address

1050 UNIVERSITY AVE STE E107 #707
SAN DIEGO CA
92103-3359
US

V. Phone/Fax

Practice location:
  • Phone: 619-259-0744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LEA M ROMAN
Title or Position: OWNER
Credential: LPCC
Phone: 214-789-9025