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General NPI Number Information
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NPI Number | 1477782670
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Entity Type | Organization
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Legal Business Name | ROOTS & WINGS INDIVIDUAL AND FAMILY COUNSELING ASSOCIATES INC
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 8356 ALLISON AVE SUITE B2
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City | LA MESA
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State | CA
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Zip | 91941-3857
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Country | US
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Telephone | 619-737-7721
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Fax |
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Provider Business Mailing Address
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Address Line | 7918 EL CAJON BLVD SUITE N #307
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City | LA MESA
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State | CA
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Zip | 91941-3710
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Country | US
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Telephone | 619-737-7721
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. AISHA D POPE
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Credential | LCSW
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Telephone | 619-737-7721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFCC45648
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS23510
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License Number State | CA
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