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General NPI Number Information
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NPI Number | 1215697990
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Entity Type | Organization
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Legal Business Name | TANIA BEAUDOIN LICENSED CLINICAL SOCIAL WORKER INC
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 2580 CATAMARAN WAY
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City | CHULA VISTA
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State | CA
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Zip | 91914-4533
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Country | US
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Telephone | 619-500-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 2027 MOUNT LANGLEY ST
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City | CHULA VISTA
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State | CA
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Zip | 91913-1613
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Country | US
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Telephone | 619-500-6120
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | TANIA MARIE BEAUDOIN
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Credential | LCSW
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Telephone | 619-500-6120
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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 |
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License Number State |
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