Healthcare Provider Details

I. General information

NPI: 1881527828
Provider Name (Legal Business Name): EMBODIED LIVING COUNSELING LICENSED PROFESSIONAL CLINICAL COUNSELOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 WESTSIDE DR APT 306
SAN DIEGO CA
92108-1214
US

IV. Provider business mailing address

7770 WESTSIDE DR APT 306
SAN DIEGO CA
92108-1214
US

V. Phone/Fax

Practice location:
  • Phone: 619-701-6077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH CALABRESE
Title or Position: PRESIDENT
Credential: LPCC
Phone: 619-701-6077