Healthcare Provider Details

I. General information

NPI: 1184858722
Provider Name (Legal Business Name): COUNSELING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12486 RIOS RD
SAN DIEGO CA
92128-2841
US

IV. Provider business mailing address

12486 RIOS RD
SAN DIEGO CA
92128-2841
US

V. Phone/Fax

Practice location:
  • Phone: 858-217-7083
  • Fax: 619-326-8952
Mailing address:
  • Phone: 858-217-7083
  • Fax: 619-326-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1039
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: GEORGE AUSTAIN SUITER
Title or Position: PRESIDENT
Credential: PSYD/LCSW
Phone: 858-217-7083