Provider Demographics
NPI:1588793319
Name:WEST, VIRGINIA ELLEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ELLEN
Last Name:WEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9262 SAMANTHA CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2165
Mailing Address - Country:US
Mailing Address - Phone:858-484-8745
Mailing Address - Fax:
Practice Address - Street 1:3255 CAMINO DEL RIO S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3806
Practice Address - Country:US
Practice Address - Phone:619-563-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 119151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical