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General NPI Number Information
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NPI Number | 1831693738
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Entity Type | Individual
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Provider Name | JUSTIN WERLICK
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Gender | Male
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 928 BROADWAY
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City | SAN DIEGO
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State | CA
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Zip | 92101-5514
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Country | US
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Telephone | 619-977-3716
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Fax |
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Provider Business Mailing Address
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Address Line | 8148 GENESEE AVE APT 147
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City | SAN DIEGO
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State | CA
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Zip | 92122-1463
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Country | US
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Telephone |
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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 |
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License Number State |
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