Healthcare Provider Details

I. General information

NPI: 1639449655
Provider Name (Legal Business Name): YMCA OF SAN DIEGO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 30TH ST
SAN DIEGO CA
92116-4232
US

IV. Provider business mailing address

4451 30TH ST
SAN DIEGO CA
92116-4232
US

V. Phone/Fax

Practice location:
  • Phone: 619-281-8313
  • Fax: 619-281-8324
Mailing address:
  • Phone: 619-281-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHERINE ELIZABETH DEMMLER
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 619-281-8313