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General NPI Number Information
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NPI Number | 1790354207
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Entity Type | Organization
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Legal Business Name | GOLDEN STATE CLINICAL COUNSELING, A
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Dates
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Enumeration Date | 06/19/2021
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Last Update Date | 04/30/2024
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Provider Practice Location Address
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Address Line | 8880 RIO SAN DIEGO DR STE 800
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City | SAN DIEGO
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State | CA
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Zip | 92108-1642
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Country | US
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Telephone | 760-557-5572
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Fax |
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Provider Business Mailing Address
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Address Line | 8880 RIO SAN DIEGO DR STE 800
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City | SAN DIEGO
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State | CA
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Zip | 92108-1642
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Country | US
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Telephone | 760-557-5572
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAYLOR MARIE TICA
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Credential | LPCC
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Telephone | 760-557-5572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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