Provider Demographics
NPI:1063122323
Name:MENTAL HEALTH ASSOCIATION IN SAN DIEGO COUNTY
Entity type:Organization
Organization Name:MENTAL HEALTH ASSOCIATION IN SAN DIEGO COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAPHYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:619-543-0412
Mailing Address - Street 1:4069 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2601
Mailing Address - Country:US
Mailing Address - Phone:619-543-0412
Mailing Address - Fax:619-285-8185
Practice Address - Street 1:4069 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2601
Practice Address - Country:US
Practice Address - Phone:619-543-0412
Practice Address - Fax:619-285-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty