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General NPI Number Information
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NPI Number | 1801031984
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Entity Type | Organization
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Legal Business Name | S.A.G.E. THERAPY CENTER
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | 2774 JEFFERSON ST
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City | CARLSBAD
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State | CA
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Zip | 92008-1703
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Country | US
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Telephone | 858-779-1099
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 CAMINITO SEPTIMO
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City | CARDIFF
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State | CA
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Zip | 92007-1028
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Country | US
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Telephone | 760-703-2188
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Fax | 760-729-7050
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Authorized Official
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Title or Position | CEO
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Name | MS. KRISTIN LOUISE MOOREHEAD
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Credential | M.A. MFT
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Telephone | 760-703-2188
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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 |
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License Number State |
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