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General NPI Number Information
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NPI Number | 1326282104
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Entity Type | Organization
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Legal Business Name | COMMUNITY RESEARCH FOUNDATION
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 1260 MORENA BLVD STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92110-3850
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Country | US
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Telephone | 619-398-0355
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Fax |
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Provider Business Mailing Address
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Address Line | 4070 PORTE LA PAZ UNIT 20
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City | SAN DIEGO
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State | CA
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Zip | 92122-4817
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Country | US
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Telephone | 402-660-2388
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Fax |
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Authorized Official
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Title or Position | SUBSTANCE ABUSE SPECIALIST
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Name | SHELLY LYNN NYKODYM
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Credential |
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Telephone | 402-660-2388
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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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