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General NPI Number Information
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NPI Number | 1154624781
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Entity Type | Organization
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Legal Business Name | SD PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 10769 WOODSIDE AVE STE 205
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City | SANTEE
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State | CA
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Zip | 92071-3175
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Country | US
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Telephone | 619-448-1216
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Fax | 888-291-4799
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Provider Business Mailing Address
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Address Line | 10769 WOODSIDE AVE STE 205
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City | SANTEE
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State | CA
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Zip | 92071-3175
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Country | US
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Telephone | 619-448-1216
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Fax | 888-291-4799
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTIANA K SILVA
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Credential | PH.D.
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Telephone | 619-415-7639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 21878
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License Number State | CA
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