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General NPI Number Information
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NPI Number | 1013496421
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Entity Type | Organization
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Legal Business Name | STEPPING STONES PSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 411 CAMINO DEL RIO S STE 304
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City | SAN DIEGO
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State | CA
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Zip | 92108-3551
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Country | US
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Telephone | 314-719-7183
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Fax |
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Provider Business Mailing Address
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Address Line | 2295 BAHIA DR
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City | LA JOLLA
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State | CA
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Zip | 92037-7007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. STARR MACKINNON
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Credential | PHD
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Telephone | 619-885-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY27021
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License Number State | CA
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