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General NPI Number Information
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NPI Number | 1902428089
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Entity Type | Organization
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Legal Business Name | CHE AJAL FAMILY COUNSELING CENTER INC.
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 2165 SAN DIEGO AVE STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92110-2907
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Country | US
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Telephone | 619-779-0078
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Fax | 619-407-9049
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Provider Business Mailing Address
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Address Line | 2165 SAN DIEGO AVE STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92110-2907
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Country | US
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Telephone | 619-779-0078
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Fax | 619-407-9049
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Authorized Official
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Title or Position | CEO
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Name | BEVERLY GENOVEVA FUENTES
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Credential | LMFT 106356
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Telephone | 619-779-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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