Provider Demographics
NPI:1356077390
Name:DISCOVERY AND GROWTH PSYCHOTHERAPY, INC
Entity Type:Organization
Organization Name:DISCOVERY AND GROWTH PSYCHOTHERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASNOCL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-339-1840
Mailing Address - Street 1:5252 BALBOA AVE STE 801
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5252 BALBOA AVE STE 801
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6970
Practice Address - Country:US
Practice Address - Phone:760-853-1097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-30
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255728879OtherNPI