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General NPI Number Information
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NPI Number | 1053633198
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Entity Type | Organization
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Legal Business Name | DESICOUCH
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 61 AIRPORT BLVD. STE. C
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080
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Country | US
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Telephone | 415-267-4850
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Fax | 415-267-4850
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Provider Business Mailing Address
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Address Line | 61 AIRPORT BLVD STE. C
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-6522
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Country | US
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Telephone | 415-267-4850
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Fax | 415-267-4850
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS DESDEMONIA WHITTLE
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Credential | MFT
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Telephone | 415-267-4850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 43971
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License Number State | CA
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