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General NPI Number Information
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NPI Number | 1891098307
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Entity Type | Organization
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Legal Business Name | RE SPECTRUM COMMUNITY
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 10769 WOODSIDE AVE
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City | SANTEE
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State | CA
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Zip | 92071-3174
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Country | US
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Telephone | 619-301-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 THOMAS AVE
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City | SAN DIEGO
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State | CA
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Zip | 92109-4161
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Country | US
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Telephone | 619-301-4041
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | COURTNEY OLINGER
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Credential | PSYD
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Telephone | 619-301-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | MFC 49051
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License Number State | CA
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