Provider Demographics
NPI:1962134189
Name:HILL, ALFRED ZIMBALIST (MPSS, SUDRC)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:ZIMBALIST
Last Name:HILL
Suffix:
Gender:M
Credentials:MPSS, SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 JEFFREE ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3803
Mailing Address - Country:US
Mailing Address - Phone:619-804-9716
Mailing Address - Fax:
Practice Address - Street 1:4104 DELTA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-4113
Practice Address - Country:US
Practice Address - Phone:619-264-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-COSAFV175T00000X
CA14926101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist