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General NPI Number Information
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NPI Number | 1548476708
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Entity Type | Organization
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Legal Business Name | PACIFIC BEACH MARRIAGE AND FAMILY COUNSELING, INC.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1010 TURQUOISE ST STE 265
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City | SAN DIEGO
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State | CA
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Zip | 92109-1200
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Country | US
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Telephone | 858-488-5732
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Fax | 858-273-8517
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Provider Business Mailing Address
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Address Line | 1010 TURQUOISE ST STE 265
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City | SAN DIEGO
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State | CA
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Zip | 92109-1200
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Country | US
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Telephone | 858-488-5732
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Fax | 858-273-8517
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID MARTIN HENDRICK
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Credential | M.S.
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Telephone | 858-488-5732
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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 | MFT#24460
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License Number State | CA
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