Provider Demographics
NPI:1376996363
Name:HEALING HEARTS COUNSELING CENTER SAN DIEGO INCORPORATED
Entity Type:Organization
Organization Name:HEALING HEARTS COUNSELING CENTER SAN DIEGO INCORPORATED
Other - Org Name:HEALING HEARTS COUNSELING CENTER SAN DIEGO INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DELORIS
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:760-458-1600
Mailing Address - Street 1:317 N EL CAMINO REAL STE 306
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2814
Mailing Address - Country:US
Mailing Address - Phone:760-458-1600
Mailing Address - Fax:
Practice Address - Street 1:317 N EL CAMINO REAL STE 306
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2814
Practice Address - Country:US
Practice Address - Phone:760-458-1600
Practice Address - Fax:858-673-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2992101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA863744122OtherMEDICARE