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General NPI Number Information
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NPI Number | 1902922206
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Entity Type | Individual
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Provider Name | LINDA DIANE DAUGHERTY MFT
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 MATA WAY STE 101
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City | SAN MARCOS
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State | CA
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Zip | 92069-2936
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Country | US
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Telephone | 760-510-4737
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Fax | 760-510-4738
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Provider Business Mailing Address
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Address Line | 1918 ELM RIDGE DR
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City | VISTA
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State | CA
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Zip | 92081-7344
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Country | US
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Telephone | 760-734-3889
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 30267
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License Number State | CA
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