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General NPI Number Information
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NPI Number | 1538809967
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Entity Type | Organization
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Legal Business Name | NUBIA A PENA OFFERDAHL, LICENSED CLINICAL SOCIAL WORKER, INC
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 7777 ALVARADO RD STE 315
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City | LA MESA
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State | CA
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Zip | 91942-8247
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Country | US
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Telephone | 619-493-2136
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Fax | 619-303-0287
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Provider Business Mailing Address
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Address Line | 2650 JAMACHA RD STE 147
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City | EL CAJON
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State | CA
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Zip | 92019-4319
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Country | US
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Telephone | 619-493-2136
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Fax | 619-303-0287
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Authorized Official
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Title or Position | PRESIDENT
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Name | NUBIA ANGELA ANGELA PENA OFFERDAHL
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Credential | LCSW
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Telephone | 619-493-2136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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