Provider Demographics
NPI:1528102175
Name:DAWIDOWICZ, CAROL SIMPSON (MFT)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SIMPSON
Last Name:DAWIDOWICZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:KIRKLAND
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3761 VILLA TER APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3491
Mailing Address - Country:US
Mailing Address - Phone:858-568-0456
Mailing Address - Fax:
Practice Address - Street 1:5480 BALTIMORE DR
Practice Address - Street 2:SUITE #250
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2020
Practice Address - Country:US
Practice Address - Phone:858-568-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist