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General NPI Number Information
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NPI Number | 1104550359
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Entity Type | Organization
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Legal Business Name | JESSICA A MILLANPONCE, LICENSED CLINICAL SOCIAL WORKER, PC
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 7290 NAVAJO RD STE 109
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City | SAN DIEGO
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State | CA
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Zip | 92119-1631
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Country | US
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Telephone | 619-875-1512
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 710971
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City | SANTEE
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State | CA
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Zip | 92072-0971
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Country | US
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Telephone | 760-983-6684
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | JESSICA A MILLANPONCE
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Credential | LCSW
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Telephone | 760-983-6684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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