Healthcare Provider Details

I. General information

NPI: 1881128676
Provider Name (Legal Business Name): KIRSTIN HALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 CAMINO DEL RIO S STE 200
SAN DIEGO CA
92108-4016
US

IV. Provider business mailing address

9257 LAKE MURRAY BLVD UNIT D
SAN DIEGO CA
92119-1400
US

V. Phone/Fax

Practice location:
  • Phone: 888-616-0864
  • Fax: 619-333-8922
Mailing address:
  • Phone: 619-871-5126
  • Fax: 619-333-8922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIRSTIN HALL
Title or Position: CEO
Credential:
Phone: 888-616-0864