Provider Demographics
NPI:1063637015
Name:COUNSELING & BEHAVIORAL SPECIALISTS, AFCC
Entity Type:Organization
Organization Name:COUNSELING & BEHAVIORAL SPECIALISTS, AFCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JORDANNA
Authorized Official - Middle Name:FERN
Authorized Official - Last Name:WASILESKU
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, RPT-S
Authorized Official - Phone:619-697-0470
Mailing Address - Street 1:9029 PARK PLAZA DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3436
Mailing Address - Country:US
Mailing Address - Phone:619-697-0470
Mailing Address - Fax:619-697-0505
Practice Address - Street 1:9029 PARK PLAZA DR
Practice Address - Street 2:SUITE #101
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3436
Practice Address - Country:US
Practice Address - Phone:619-697-0470
Practice Address - Fax:619-697-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty