Healthcare Provider Details

I. General information

NPI: 1760179030
Provider Name (Legal Business Name): SEEKING SANCTUARY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 ADAMS AVE
SAN DIEGO CA
92116-1401
US

IV. Provider business mailing address

8301 MISSION GORGE RD SPC 86
SANTEE CA
92071-3580
US

V. Phone/Fax

Practice location:
  • Phone: 619-937-1900
  • Fax: 619-350-4445
Mailing address:
  • Phone: 619-937-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SANDRA LEE KNICKERBOCKER
Title or Position: LMFT/PRESIDENT
Credential: LMFT
Phone: 619-937-1900