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General NPI Number Information
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NPI Number | 1710647060
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Entity Type | Organization
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Legal Business Name | SAFE ROOTS COUNSELING
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Dates
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Enumeration Date | 12/28/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 4075 PARK BLVD STE 102-218
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City | SAN DIEGO
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State | CA
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Zip | 92103-2670
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Country | US
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Telephone | 619-929-0726
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Fax |
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Provider Business Mailing Address
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Address Line | 4032 ALABAMA ST APT 1D
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City | SAN DIEGO
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State | CA
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Zip | 92104-6082
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Country | US
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Telephone | 310-666-2408
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. ODELIA MOROVATI
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Credential | LMFT
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Telephone | 310-666-2408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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