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General NPI Number Information
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NPI Number | 1992318893
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Entity Type | Organization
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Legal Business Name | PSYCHDOC INC, A PROFESSIONAL PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 2650 CAMINO DEL RIO N STE 108
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City | SAN DIEGO
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State | CA
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Zip | 92108-1631
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Country | US
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Telephone | 877-815-8845
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 PALOMAR AIRPORT RD STE 214-16
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City | CARLSBAD
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State | CA
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Zip | 92011-4402
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Country | US
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Telephone | 877-815-8845
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Fax | 833-282-1430
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Authorized Official
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Title or Position | CEO
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Name | DR. JESSICA M STEVENS
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Credential | PHD
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Telephone | 877-815-8845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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