Provider Demographics
NPI:1245426782
Name:KRISSIE LE-HERMIDA
Entity Type:Organization
Organization Name:KRISSIE LE-HERMIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISSIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:LE-HERMIDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-960-9645
Mailing Address - Street 1:625 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5703
Mailing Address - Country:US
Mailing Address - Phone:619-960-9645
Mailing Address - Fax:619-476-7566
Practice Address - Street 1:625 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5703
Practice Address - Country:US
Practice Address - Phone:619-960-9645
Practice Address - Fax:619-476-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS15235261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)