Healthcare Provider Details

I. General information

NPI: 1922379049
Provider Name (Legal Business Name): THE SAN DIEGO LGBT COMMUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 CENTRE STREET
SAN DIEGO CA
92103
US

IV. Provider business mailing address

PO BOX 3357
SAN DIEGO CA
92163
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-2077
  • Fax: 619-260-3093
Mailing address:
  • Phone: 619-692-2077
  • Fax: 619-260-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number16841
License Number StateCA

VIII. Authorized Official

Name: ELIZABETH BARNES
Title or Position: DIR. OF OPERATIONS
Credential: LCSW
Phone: 619-692-2077