Healthcare Provider Details

I. General information

NPI: 1215443551
Provider Name (Legal Business Name): MONICA JOY THOELKE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7879 ALTANA WAY
SAN DIEGO CA
92108-2624
US

IV. Provider business mailing address

7879 ALTANA WAY
SAN DIEGO CA
92108-2624
US

V. Phone/Fax

Practice location:
  • Phone: 707-772-7507
  • Fax:
Mailing address:
  • Phone: 707-772-7507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number113892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: