Provider Demographics
NPI:1003560632
Name:CANVAS OF POSSIBILITIES PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:CANVAS OF POSSIBILITIES PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:NIKOLAYEVNA
Authorized Official - Last Name:KHOLODOVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-805-5302
Mailing Address - Street 1:3033 FIFTH AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5873
Mailing Address - Country:US
Mailing Address - Phone:858-805-5302
Mailing Address - Fax:
Practice Address - Street 1:3033 FIFTH AVE STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5873
Practice Address - Country:US
Practice Address - Phone:858-805-5302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health