Healthcare Provider Details

I. General information

NPI: 1609331248
Provider Name (Legal Business Name): ANGELITA DOMINIQUE CORTEZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 06/30/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEALTHY MINDS COUNSELING SERVICES 591 CAMINO DE LA REINA, SUITE 210
SAN DIEGO CA
92108
US

IV. Provider business mailing address

HEALTHY MINDS COUNSELING SERVICES 591 CAMINO DE LA REINA, SUITE 210
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-206-5271
  • Fax: 619-795-3274
Mailing address:
  • Phone: 619-206-5271
  • Fax: 619-795-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6037
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: