Healthcare Provider Details

I. General information

NPI: 1437788700
Provider Name (Legal Business Name): FIRST ALARM WELLNESS, A FAMILY COUNSELING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 ALTA VISTA DR STE 202
VISTA CA
92084-5506
US

IV. Provider business mailing address

630 ALTA VISTA DR STE 202
VISTA CA
92084-5506
US

V. Phone/Fax

Practice location:
  • Phone: 760-650-4128
  • Fax: 888-464-4455
Mailing address:
  • Phone: 760-650-4128
  • Fax: 888-464-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA CASOLA
Title or Position: PRESIDENT
Credential: LMFT
Phone: 760-275-1469