=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417180332
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATION FOR COMPASSIONATE TRANSFORMATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2009
-----------------------------------------------------
Last Update Date | 01/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12526 HIGH BLUFF DR STE. 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-2064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-792-3541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12526 HIGH BLUFF DR. STE. 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-792-3541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ALEKSANDRA DRECUN
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 858-792-3541
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY21778
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------