Healthcare Provider Details

I. General information

NPI: 1831223247
Provider Name (Legal Business Name): UPAC ADDICTION TREATMENT AND RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3288 EL CAJON BLVD. SUITES 13, 12, 11, 10, 6, 3
SAN DIEGO CA
92104-1430
US

IV. Provider business mailing address

3288 EL CAJON BLVD STE 13
SAN DIEGO CA
92104-1430
US

V. Phone/Fax

Practice location:
  • Phone: 619-521-5720
  • Fax:
Mailing address:
  • Phone: 619-521-5720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY BOATMAN
Title or Position: PROGRAM DIRECTOR
Credential: LMFT
Phone: 619-521-5720