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General NPI Number Information
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NPI Number | 1770211591
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Entity Type | Individual
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Provider Name | CASSIE DIANE MCGOWAN SUDRC
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Gender | Female
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 10201 MISSION GORGE RD STE C
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City | SANTEE
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State | CA
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Zip | 92071-3026
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Country | US
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Telephone | 619-383-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 10201 MISSION GORGE RD
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City | SANTEE
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State | CA
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Zip | 92071-3027
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Country | US
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Telephone | 619-383-6868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17879
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 17879
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License Number State | CA
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