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General NPI Number Information
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NPI Number | 1063303881
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Entity Type | Organization
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Legal Business Name | SOUL FILLED THERAPY LICENSED CLINICAL SOCIAL WORKER PC
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1337 CAMINO DEL MAR STE B
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City | DEL MAR
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State | CA
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Zip | 92014-2504
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Country | US
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Telephone | 858-342-9286
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Fax |
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Provider Business Mailing Address
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Address Line | 3830 VALLEY CENTRE DR PMB 813 STE 705
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City | SAN DIEGO
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State | CA
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Zip | 92130-3320
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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 | DIRECTOR
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Name | ILANA MOLKNER
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Credential | LCSW
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Telephone | 858-342-9286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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