Provider Demographics
NPI:1073028742
Name:ADR WELLNESS A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:ADR WELLNESS A PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LEAD PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCLOS-ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-793-8063
Mailing Address - Street 1:785 GRAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2370
Mailing Address - Country:US
Mailing Address - Phone:760-793-8063
Mailing Address - Fax:
Practice Address - Street 1:785 GRAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2370
Practice Address - Country:US
Practice Address - Phone:760-793-8063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20363103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty