Provider Demographics
NPI:1003063892
Name:NORTH COUNTY LIFELINE
Entity Type:Organization
Organization Name:NORTH COUNTY LIFELINE
Other - Org Name:NCL OCEANSIDE SCHOOL BASED
Other - Org Type:Other Name
Authorized Official - Title/Position:DRIECTOR OF BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:760-757-0118
Mailing Address - Street 1:707 OCEANSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5225
Mailing Address - Country:US
Mailing Address - Phone:760-726-4900
Mailing Address - Fax:760-631-0778
Practice Address - Street 1:707 OCEANSIDE BLVD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5225
Practice Address - Country:US
Practice Address - Phone:760-726-4900
Practice Address - Fax:760-631-0778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COUNTY LIFELINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADMH 37EC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health