Provider Demographics
NPI:1417998378
Name:ALPHA OF SAN DIEGO, INC.
Entity Type:Organization
Organization Name:ALPHA OF SAN DIEGO, INC.
Other - Org Name:ALPHA BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUCKOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-285-9999
Mailing Address - Street 1:4069 30TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-2601
Mailing Address - Country:US
Mailing Address - Phone:619-285-9999
Mailing Address - Fax:619-285-1938
Practice Address - Street 1:4069 30TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2601
Practice Address - Country:US
Practice Address - Phone:619-285-9999
Practice Address - Fax:619-285-1938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15358103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty