Healthcare Provider Details

I. General information

NPI: 1992318893
Provider Name (Legal Business Name): PSYCHDOC INC, A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 CAMINO DEL RIO N STE 108
SAN DIEGO CA
92108-1631
US

IV. Provider business mailing address

2100 PALOMAR AIRPORT RD STE 214-16
CARLSBAD CA
92011-4402
US

V. Phone/Fax

Practice location:
  • Phone: 877-815-8845
  • Fax:
Mailing address:
  • Phone: 877-815-8845
  • Fax: 833-282-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSICA M STEVENS
Title or Position: CEO
Credential: PHD
Phone: 877-815-8845