Provider Demographics
NPI:1427112937
Name:MISSION VALLEY COUNSELING ASSOCIATES, INC
Entity type:Organization
Organization Name:MISSION VALLEY COUNSELING ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-282-4600
Mailing Address - Street 1:3511 CAMINO DEL RIO S
Mailing Address - Street 2:500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4003
Mailing Address - Country:US
Mailing Address - Phone:619-282-4600
Mailing Address - Fax:619-624-0178
Practice Address - Street 1:3511 CAMINO DEL RIO S
Practice Address - Street 2:500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4003
Practice Address - Country:US
Practice Address - Phone:619-282-4600
Practice Address - Fax:619-624-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS105191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW10519Medicare ID - Type UnspecifiedSOCIAL WORKER