Healthcare Provider Details

I. General information

NPI: 1144148560
Provider Name (Legal Business Name): PEP DBT LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 CAMINO DEL RIO S STE 112
SAN DIEGO CA
92108-3546
US

IV. Provider business mailing address

438 CAMINO DEL RIO S STE 112
SAN DIEGO CA
92108-3546
US

V. Phone/Fax

Practice location:
  • Phone: 619-787-6676
  • Fax:
Mailing address:
  • Phone: 619-787-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARGARET BOYD
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 619-318-9818