Provider Demographics
NPI:1598827560
Name:MATHIE-ENCISO, LILIA (LMFCC)
Entity type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:MATHIE-ENCISO
Suffix:
Gender:F
Credentials:LMFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 3RD AVE
Mailing Address - Street 2:ST 215
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1307
Mailing Address - Country:US
Mailing Address - Phone:619-420-6088
Mailing Address - Fax:
Practice Address - Street 1:815 3RD AVE
Practice Address - Street 2:ST 215
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1307
Practice Address - Country:US
Practice Address - Phone:619-420-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFCC 24463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health