Provider Demographics
NPI:1104474493
Name:AMUNDSON, ASHLEY RACHAEL (PCCI)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:RACHAEL
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6780 FRIARS RD UNIT 322
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1192
Mailing Address - Country:US
Mailing Address - Phone:619-993-8829
Mailing Address - Fax:
Practice Address - Street 1:2912 MANAGUA PL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-7105
Practice Address - Country:US
Practice Address - Phone:619-993-8829
Practice Address - Fax:760-683-5152
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health