Provider Demographics
NPI:1962973842
Name:DIZON, VERONNA BONGGAT (LCSW, PMH-C)
Entity type:Individual
Prefix:
First Name:VERONNA
Middle Name:BONGGAT
Last Name:DIZON
Suffix:
Gender:F
Credentials:LCSW, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212732
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91921-2732
Mailing Address - Country:US
Mailing Address - Phone:619-403-9772
Mailing Address - Fax:619-354-7228
Practice Address - Street 1:918 LAFAYETTE PL
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3158
Practice Address - Country:US
Practice Address - Phone:619-482-3804
Practice Address - Fax:619-354-7228
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty