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General NPI Number Information
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NPI Number | 1104360965
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Entity Type | Organization
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Legal Business Name | GROWTHWELL COUNSELING
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 2831 CAMINO DEL RIO S STE 112
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City | SAN DIEGO
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State | CA
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Zip | 92108-3707
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Country | US
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Telephone | 619-808-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 4643 WILSON AVE APT 5
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City | SAN DIEGO
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State | CA
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Zip | 92116-3577
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Country | US
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Telephone | 619-808-4477
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Fax |
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Authorized Official
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Title or Position | OWNER-THERAPIST
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Name | MR. JUAN MANUEL CALDERON-AGUIRRE
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Credential | LCSW
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Telephone | 619-808-4477
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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 | 71796
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License Number State | CA
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