Provider Demographics
NPI:1235782335
Name:RAMIREZ/WITHERSPOON, KASSANDRA ADRIANNA (PEER COUNSELOR)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:ADRIANNA
Last Name:RAMIREZ/WITHERSPOON
Suffix:
Gender:F
Credentials:PEER COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 TEXAS ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3723
Mailing Address - Country:US
Mailing Address - Phone:619-692-0727
Mailing Address - Fax:619-692-0785
Practice Address - Street 1:5005 TEXAS ST STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3723
Practice Address - Country:US
Practice Address - Phone:619-692-0727
Practice Address - Fax:619-692-0785
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor