Provider Demographics
NPI:1366014169
Name:LAI, TINA (ASW, MSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:LAI
Suffix:
Gender:F
Credentials:ASW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W MISSION AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1721
Mailing Address - Country:US
Mailing Address - Phone:626-807-6559
Mailing Address - Fax:
Practice Address - Street 1:125 W MISSION AVE STE 103
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1721
Practice Address - Country:US
Practice Address - Phone:760-257-2849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 390200000X
CAASW104208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health