Provider Demographics
NPI:1326664731
Name:GIACOMINI, ANDRESSA GOMES (AMFT)
Entity Type:Individual
Prefix:
First Name:ANDRESSA
Middle Name:GOMES
Last Name:GIACOMINI
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6219 STANLEY AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-4048
Mailing Address - Country:US
Mailing Address - Phone:781-426-5146
Mailing Address - Fax:
Practice Address - Street 1:3230 WARING CT STE A
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-305-7528
Practice Address - Fax:760-509-4410
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT117080101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor