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General NPI Number Information
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NPI Number | 1922379049
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Entity Type | Organization
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Legal Business Name | THE SAN DIEGO LGBT COMMUNITY CENTER
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 02/08/2018
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Provider Practice Location Address
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Address Line | 3909 CENTRE STREET
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City | SAN DIEGO
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State | CA
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Zip | 92103
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Country | US
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Telephone | 619-692-2077
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Fax | 619-260-3093
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Provider Business Mailing Address
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Address Line | PO BOX 3357
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City | SAN DIEGO
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State | CA
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Zip | 92163
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Country | US
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Telephone | 619-692-2077
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Fax | 619-260-3093
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Authorized Official
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Title or Position | DIR. OF OPERATIONS
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Name | ELIZABETH BARNES
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Credential | LCSW
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Telephone | 619-692-2077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 16841
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License Number State | CA
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