Healthcare Provider Details

I. General information

NPI: 1922921899
Provider Name (Legal Business Name): JUSTINE RICHEY ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 EL CAJON BLVD
SAN DIEGO CA
92104-1292
US

IV. Provider business mailing address

12942 PEPPERGRASS CREEK GATE UNIT 52
SAN DIEGO CA
92130-2923
US

V. Phone/Fax

Practice location:
  • Phone: 866-940-9691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number124692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: