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General NPI Number Information
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NPI Number | 1083936983
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Entity Type | Individual
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Provider Name | HOLLY DIANA HASTINGS GINES LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 135 E 3RD AVE STE. B
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City | ESCONDIDO
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State | CA
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Zip | 92025-4252
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Country | US
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Telephone | 760-705-8468
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Fax | 760-735-2922
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Provider Business Mailing Address
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Address Line | 105 N ROSE ST STE. 211
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City | ESCONDIDO
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State | CA
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Zip | 92027-7222
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Country | US
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Telephone | 760-705-8468
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Fax | 760-735-2922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LCS20560
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License Number State | CA
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