Healthcare Provider Details

I. General information

NPI: 1710647060
Provider Name (Legal Business Name): SAFE ROOTS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 PARK BLVD STE 102-218
SAN DIEGO CA
92103-2670
US

IV. Provider business mailing address

4032 ALABAMA ST APT 1D
SAN DIEGO CA
92104-6082
US

V. Phone/Fax

Practice location:
  • Phone: 619-929-0726
  • Fax:
Mailing address:
  • Phone: 310-666-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ODELIA MOROVATI
Title or Position: THERAPIST
Credential: LMFT
Phone: 310-666-2408