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General NPI Number Information
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NPI Number | 1861899080
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Entity Type | Organization
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Legal Business Name | ANGELA D COPELAND
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 3525 4TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-4912
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Country | US
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Telephone | 760-449-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 5120 MOUNT HELIX DR
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City | LA MESA
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State | CA
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Zip | 91941-4358
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Country | US
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Telephone | 760-449-1888
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. ANGELA COPELAND
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Credential | PSY.D.
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Telephone | 760-449-1888
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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 | 39137
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY22974
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License Number State | CA
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