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General NPI Number Information
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NPI Number | 1386150159
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Entity Type | Individual
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Provider Name | MICHELLE STEAD
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Gender | Female
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Dates
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Enumeration Date | 12/15/2017
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Last Update Date | 07/19/2019
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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 | 10201 MISSION GORGE RD STE O
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City | SANTEE
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State | CA
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Zip | 92071-3027
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Country | US
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Telephone | 619-385-3918
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12987-R
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 12987-R
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License Number State | CA
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