Provider Demographics
NPI:1083165971
Name:SAN DIEGO STUDENT RECOVERY
Entity Type:Organization
Organization Name:SAN DIEGO STUDENT RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-723-1581
Mailing Address - Street 1:5440 MOREHOUSE DR
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5440 MOREHOUSE DR
Practice Address - Street 2:SUITE 4500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1798
Practice Address - Country:US
Practice Address - Phone:619-723-1581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOBER COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health