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General NPI Number Information
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NPI Number | 1962249318
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Entity Type | Organization
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Legal Business Name | CALIFORNIA PACIFIC COUNSELING CENTER
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Dates
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Enumeration Date | 07/12/2024
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 770 1ST AVE STE 250
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City | SAN DIEGO
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State | CA
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Zip | 92101-6170
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Country | US
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Telephone | 714-713-3890
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Fax |
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Provider Business Mailing Address
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Address Line | 620 STATE ST UNIT 421
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City | SAN DIEGO
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State | CA
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Zip | 92101-6725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MARY ANN FORNES
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Credential | LMFT
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Telephone | 714-713-8890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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