=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811792039
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEIGHBORHOOD HOUSE ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5473 KEARNY VILLA RD STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-737-2768
-----------------------------------------------------
Fax | 619-684-7004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5473 KEARNY VILLA RD STE 300
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92123-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-737-2768
-----------------------------------------------------
Fax | 619-684-7004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR PROGRAM DIRECTOR
-----------------------------------------------------
Name | DESIREE BRITTAIN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 619-993-2519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------