Healthcare Provider Details

I. General information

NPI: 1780446070
Provider Name (Legal Business Name): ABITARE FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 RUFFIN RD STE 150
SAN DIEGO CA
92123-1876
US

IV. Provider business mailing address

4181 RUFFIN RD STE 150
SAN DIEGO CA
92123-1876
US

V. Phone/Fax

Practice location:
  • Phone: 800-613-8144
  • Fax: 619-860-0676
Mailing address:
  • Phone: 800-613-8144
  • Fax: 619-860-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JOSETTE CANNON
Title or Position: DIRECTOR
Credential:
Phone: 619-310-3633