Healthcare Provider Details

I. General information

NPI: 1154933018
Provider Name (Legal Business Name): THOMAS HUNTER SIGGINS ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOMMY SIGGINS

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 BALBOA AVE STE 408
SAN DIEGO CA
92117-6939
US

IV. Provider business mailing address

5252 BALBOA AVE STE 408
SAN DIEGO CA
92117-6939
US

V. Phone/Fax

Practice location:
  • Phone: 858-333-6856
  • Fax: 858-999-2014
Mailing address:
  • Phone: 858-333-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108218
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: